2015 Medicaid (MassHealth) Numbers for Nursing Home Residents and Their Spouses

The Personal Needs Allowance (PNA) is $72.80. A person who lives in a nursing home and has qualified for MassHealth benefits to pay for his or her care may keep $72.80/month as a personal needs allowance to pay for items that are not covered by MassHealth. The MassHealth recipient may also keep the income needed to pay premiums for his or her existing supplemental health insurance policies, such as BC/BS Medex. If the MassHealth recipient is married and the spouse's income is less than the Minimum Monthly Maintenance Needs allowance, some or all of the MassHealth recipient's income can be given to the Community Spouse.

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is $1,991.25. If the spouse of a MassHealth recipient, referred to as the "Community Spouse" is living in the couple's home or in an assisted living facility, he or she is entitled to keep all of his or her income. If his or her income is not sufficient to pay for his or her living expenses (as determined by MassHealth standards), he or she may keep a minimum amount of the couple's combined income to pay for living expenses. The minimum amount that the community spouse may keep, without any questions asked, is $1,991.25/month. If this amount is not sufficient to pay for the Community Spouse's living expenses, he or she must submit proof that he or she needs more than the standard allowance. The maximum that the Community Spouse may keep is $2,981/month.

The Community Spouse Resource Allowance (CPRA) is $119,220. If the person who qualifies for MassHealth is married, the Community Spouse may keep the couple's primary residence, a motor vehicle, and all personal items (such as the contents of the home). In addition, the community spouse may keep financial assets and other real estate (such as a vacation home), with a total value of $119,220. The MassHealth recipient may keep only $2,000. If the value of the couple's financial assets plus a vacation home exceeds $119,220, the couple must "spend down" the excess assets on permissible items, which include the purchasing of a prepaid funeral contract for each spouse ($10,000 for each spouse is reasonable), opening a burial needs account holding $1,500 for each spouse, purchasing burial lots, paying off a mortgage or other debt, making house repairs, paying legal fees for estate planning documents or assistance in applying for MassHealth, and purchasing personal items (such as clothing, toiletries, a television, or furniture). Any remaining funds must be spent on nursing home bills until the couple's countable assets have been reduced to $119,220. If the couple owns a vacation home and the value of the vacation home plus the financial assets exceeds $119,220, the vacation home must be sold and the proceeds used for permissible spend down items or nursing home bills until the couple's financial assets are reduced to $119,220.

Excess assets cannot be gifted at the last minute to qualify you for benefits. A gift to anyone other than a spouse or a disabled child results in a five year disqualification period for MassHealth benefits. If you plan in advance, before you need nursing home care, gifting is a good strategy for protecting assets from long term nursing home care. You can gift directly to children and other family members or you can gift to an Irrevocable Trust, under which you retain the right to income.

For more detailed information about the MassHealth program, see the Articles titled "Planning for Long Term Care" and the "2015 MassHealth Resource Transfer Rules". If you would like to make an appointment for help with a MassHealth application or to learn more about advance planning for long term care and asset protection, please contact us to schedule a consultation.

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Roberta A. Schreiber, P.C.
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