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  • Writer's pictureMargot G. Birke

MassHealth at Home - Understanding Your Options

With the rising cost of nursing home care upwards of $12,000 per month, more and more people are staying home and receiving care. Home care, which averages $22 to $34 an hour, can be financially reasonable depending on the number of hours of care that person requires and the level of care needed. However, once the hours and the level of care increase, the costs can skyrocket.

Fortunately, in recent years, MassHealth has been expanding its coverage of care at home. There are several different programs each with their own requirements including Personal Care Attendant (PCA), Adult Foster Care (AFC), Frail Elder Waiver, Program for All Inclusive Care for the Elderly (PACE), and Senior Care Options (SCO).

The PCA program provides about $16 per hour for the number of hours approved by MassHealth toward the cost of a personal care attendant who provides assistance with activities of daily living. Under the PCA program, you hire your own attendant and manage the employment relationship. It can be a family member but not someone who is legally responsible for the application, such as a parent of a minor or spouse.

Adult Foster Care provides up to $18,000 per year toward the cost of care for a live-in caregiver. Similar to the PCA program, the caregiver can be a family member but not a legally responsible party. The payment is treated as a stipend and therefore not taxable income for the provider.

The Frail Elder Waiver provides a variety of services to eligible applicants at home such as personal care services, housekeeping, laundry, home health aides, skilled nursing, companion services, meal delivery, grocery shopping and transportation. These programs are available for individuals 65 and over or 60 and over and disabled and must meet clinical needs. MassHealth contracts with certain agencies to provide services doe a certain number of hours approved.

The PACE program is an all-inclusive program for those 55 and older that provides medical care and supplies, prescription drugs, dental and vision services, as well as home care and adult day health care. Applicants must agree to receive all of their care through PACE.

Finally, the Senior Care Options program is also an all-inclusive program for those 65 and older. Similar to PACE, the program provides a number of services to keep senior in the community such as medical care and supplies, prescription drugs, dental and vision services, home care and transportation to and from appointments. Again, all services must be received through SCO.

The financial eligibility rules for each program varies but is generally focused on an income limit rather than an asset limit. It is also important to note that there are additional programs available to assist with the cost of care at home through the Department of Veterans Affairs.

Figuring out the eligibility rules and determining which program or programs make the most sense in a particular situation are challenging issues that are best navigated with the help of experts.

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