Question by john d: masshealth (medicaid) eligibility?
i am unemployed and currently 61. i receive masshealth. my monthly income is 500. due to my current economic condition, my single son is deciding to move back home. if he does, he will cover all my expenses, therefore he can claim me as a dependent on his tax return, how will that affect my masshealth eligibility?
also, my son is well over 19 and pretty successful; however, not successful enough to pay for all my oop expenses AND his expenses AND my medical care

Best answer:

Answer by cam1princess
When counting family size, MassHealth includes members of your immediate family who live together, including children under 19, any of their children, and their parents. Children who are away at school are included in the family group. If you are pregnant, you should count your unborn child as part of your family.

If children are being cared for by a relative instead of their parents, the caretaker relative can decide to be part of the family or not.

If you are married with no children, your family includes you and your spouse if living together. If you are a single adult without children, your family includes just you.

Seniors age 65 or older and individuals needing long-term care who would qualify for MassHealth Standard except that their income or assets are too high, can become eligible by meeting a deductible and/or spending down their assets.

Meeting a deductible:

Seniors age 65 or older who are eligible for MassHealth Standard except that their incomes are too high, can qualify by meeting a deductible. You must show proof that your medical expenses in a six-month period are greater than your deductible amount. Your deductible is a dollar amount based on your income, your family size, and the MassHealth deductible income standard. The higher your income, the higher your deductible.

You must meet a deductible every six months. Once you meet the deductible, MassHealth provides coverage for any new covered medical expenses for the rest of the six-month period. MassHealth does not pay for the medical expenses you used to meet the deductible. You must pay these yourself.

To calculate your 6-month deductible:
# take your monthly gross family income
# subtract the deductible income standard for your family size
# multiply the excess income times 6 (for six months)

In 2007, the monthly deductible income standard is $ 522 for an individual, $ 650 for a couple, and $ 60 for residents of long-term care facilities.

There are many special rules about meeting a deductible. For more information, call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648).

Spending down your assets:

Individuals needing long-term care who do not qualify for MassHealth Standard because their assets are too high, can qualify by spending down their assets. To become eligible, you must follow MassHealth rules regarding transfer of assets:

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You must report all asset transfers for the five years before you enter a long-term care facility. This is referred to as the “look-back” period. For trust transfers, the look-back period is also five years.
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Any asset transfers during the look-back period that do not follow MassHealth rules can result in a period of ineligibility for MassHealth. The length of time that you will be ineligible depends on the value of the assets you transferred and the date of the transfer.
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You may spend down your assets within the look-back period without penalty, if you spend your money on noncountable assets or nursing home expenses. For example, you can spend your assets to fix up your home, pay down your mortgage, repair your car, or prepay your funeral expenses. You must receive fair market value for your money.
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Giving away your assets or selling them for less than fair market value during the look-back period will result in a period of ineligibility.

The asset rules for people needing long-term care are very complicated. If you have excess assets, you should get advice from Legal Services or another qualified legal advisor to make sure you spend down your assets without penalty.

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