Massachusetts Medicaid for seniors and long-term care
Last verified: June 2026
Long-term care Medicaid rules are complex
MassHealth long-term care requires in-person enrollment at a MassHealth Enrollment Center
What MassHealth covers for seniors in long-term care
MassHealth covers nursing facility care and a wide range of home and community-based services for seniors who meet both clinical (functional) and financial eligibility requirements. Massachusetts operates several HCBS waiver programs that support seniors living at home as an alternative to nursing home admission.
- Nursing facility (nursing home) care — 24-hour skilled nursing and custodial care
- Personal care attendant (PCA) services at home
- Home health aide visits
- Adult Day Health services
- Respite care for family caregivers
- Assisted living supplemental services (through Group Adult Foster Care)
- Hospice care
- Durable medical equipment and home modifications
- Skilled nursing and physical/occupational therapy at home
Source: MassHealth covered services (mass.gov/masshealth); MassHealth long-term care program guide.
MassHealth long-term care financial eligibility (2026)
MassHealth long-term care uses non-MAGI financial eligibility rules — the same asset-tested approach used in all states for nursing facility coverage. Massachusetts publishes its financial guidelines annually; the 2026 figures effective January 1, 2026 are from the official MassHealth Program Financial Guidelines at mass.gov.
| Financial figure | 2026 amount |
|---|---|
| LTC income limit (300% FBR) | $2,982/mo |
| Individual asset limit (community-based seniors) | $2,000 |
| Married couple asset limit (community-based) | $3,000 |
| Community spouse minimum resource protection (CSRA) | $32,532 |
| Community spouse maximum resource protection (CSRA) | $162,660 |
| Home equity limit (nursing facility applicant) | $1,130,000 |
| Average daily nursing facility cost (eff. 11/01/25) | $450/day |
| Personal needs allowance (nursing facility resident) | $72.80/mo |
Source: MassHealth Program Financial Guidelines, effective January 1, 2026 (mass.gov/info-details/program-financial-guidelines-for-certain-masshealth-applicants-and-members). Massachusetts's $1,130,000 home equity limit is one of the highest in the country.
Home and community-based waiver programs for Massachusetts seniors
Personal Care Attendant (PCA) Program
MassHealth's largest HCBS program. Members direct their own care — they hire, train, and supervise their own personal care attendants, including family members (spouses excluded). Administered through MassHealth's PCA Program.
Group Adult Foster Care (GAFC)
Supplemental care for seniors in assisted living settings. MassHealth pays for personal care and chore services; the member pays room and board separately. A lower-cost alternative to nursing home placement for many seniors.
Adult Foster Care (AFC)
Provides 24-hour supervision and care in a caregiver's home. Adult family members (not spouses) may be paid as caregivers. Particularly useful for seniors who cannot live independently but don't yet need a nursing facility.
Senior Care Options (SCO)
An integrated care program for seniors dually eligible for Medicare and MassHealth. SCO plans coordinate all medical and long-term care services through a single health plan — an alternative to the standard PACE program in some regions.
MassHealth estate recovery
Massachusetts participates in Medicaid estate recovery. MassHealth may seek reimbursement from the estate of a member who received long-term care services at age 55 or older, or who resided in a nursing facility. The home is generally exempt during the member's lifetime and the lifetime of a surviving spouse or qualifying dependent. Massachusetts applies a 60-month (5-year) asset transfer look-back for nursing facility applicants. An elder law attorney can help families understand these rules before assets are transferred.
Medicaid as the primary payer for long-term care
Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.
Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Massachusetts's share of that population is administered through MassHealth (Massachusetts Medicaid). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.
Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.
Nursing facility coverage
MassHealth (Massachusetts Medicaid) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.
Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.
If income exceeds the institutional Medicaid limit, Massachusetts may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Massachusetts uses this approach with MassHealth (Massachusetts Medicaid).
Home and community-based services (HCBS)
HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through MassHealth (Massachusetts Medicaid) differs from what's available in neighboring states.
Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.
Contact MassHealth (Massachusetts Medicaid) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.
Asset limits for long-term care Medicaid
Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.
Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.
Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult MassHealth (Massachusetts Medicaid) or a Medicaid planning attorney before transferring assets.
Spousal protections
When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.
The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Massachusetts's current CSRA is set by MassHealth (Massachusetts Medicaid) and published on their website.
The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).
Estate recovery applies to long-term care recipients age 55 and older
What long-term care Medicaid typically covers
- Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
- Physical, occupational, and speech therapy provided in a nursing home
- Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
- Home health aide visits for those receiving care at home
- Adult day health care programs
- Respite care to give family caregivers temporary relief
- Durable medical equipment prescribed by a physician
- Transportation to and from medical appointments