Pitfalls and Common Mistakes in the MassHealth Application Process

MassHealth coverage is, quite literally, a lifesaver. It allows Massachusetts residents to get the medical coverage and long-term nursing care that they need but can’t afford. But like most government-run programs, MassHealth applications require members to navigate a complicated process before they get covered. Here are just a few of the most common pitfalls to avoid.

Waiting Too Long to Apply

Catastrophic medical events often happen without warning, so some Massachusetts residents find themselves needing MassHealth coverage without warning. But for others, like adults over 65 or those who have worsening medical conditions, it’s easier to predict the need for long-term care. Yet some applicants don’t apply until they’re ready to move into a nursing facility.

Applying for MassHealth takes more time than you might guess. It takes some applicants weeks just to gather all the supporting documents and statements they need. Once you’ve applied, expect to wait for several more weeks or even months before hearing back from MassHealth with a decision.

If you anticipate needing MassHealth coverage in the next few years, dig into the application process right away. You may need to make some financial rearrangements now to prepare for the scrutiny your finances will receive when you apply.

Estimating Your Information

The application asks about all assets and sources of income, in addition to other personal information. You’ll need to provide amounts for your Social Security benefits, retirement or pension payments, interest you receive on any investments, deductions you take on federal income taxes, and more.

Tracking down all those figures is a hassle, so some applicants assume that giving rough estimates will suffice. MassHealth attempts to verify a lot of the financial information applicants provide. If MassHealth finds any discrepancies in the information you include, the caseworker assigned to review your application may flag it and ask you for more information. That delay can slow down the process by weeks or even months.

Making Too Many Gifts

MassHealth is a need-based program, so applicants who require long-term care have to prove that they can’t afford to pay for that care themselves. Some applicants assume that showing MassHealth proof of a meager bank balance is enough to prove financial need. Giving money and property away to loved ones is an easy way to jettison those assets and become eligible, they assume.

It’s not. MassHealth requires long-term-care applicants to submit financial statements from the previous five-year period. If you apply for this coverage but have given away large amounts during that 60-month period, you may be denied for coverage. If an applicant has a spouse who intends to continue living at home (also known as a community spouse), that person’s assets must also fall within a certain range. It’s essential to understand the current financial limits and gifting rules for MassHealth before applying.

Applying On Your Own

Think of applying for MassHealth like you’d think about selling your own home. Legally and logistically, doing this on your own is completely fine. You don’t have to enlist a realtor or other real-estate professional to help you sell your house. Many homeowners decide to take on the process alone, either because they feel it will be easy or because they don’t want to pay a professional for help.

Going it alone works out just fine for some people. But for others, the stress and aggravation of bearing this burden completely outweighs the benefits. Applying for MassHealth is similar. The application itself is long and complex. For those people who need long-term care, the application’s financial requirements are particularly inflexible. Misinterpreting the instructions or submitting incomplete information will delay your approval.

Yes, hiring an attorney or other application assistant will cost something, which might make this choice seem counterintuitive for cash-strapped residents who need help affording care. But because working with an expert can help you complete the application process quickly and correctly, this strategy can help you get your benefits faster than you would if you applied on your own.

At the Ladimer Law Office PC, we’ve helped countless applicants get approved for MassHealth. We’ve seen the mistakes that candidates make during this process, so we help our clients avoid them. We’ll work with you to make sure that your MassHealth application is completed correctly and quickly.

Will you or a loved one need MassHealth coverage in the next few years? Don’t wait. Contact Ladimer Law Office PC today!