Medicaid Long-Term Care Guide in Massachusetts
Long-term care eligibility, benefits, and how to apply through the Executive Office of Health and Human Services (EOHHS).
What makes Massachusetts Medicaid different
Medicaid in Massachusetts is called MassHealth. While jointly funded by the state and federal government, it is administered by the state under federally set parameters. In addition to care services in nursing homes, assisted living facilities, and adult foster care homes, MassHealth pays for non-medical services and supports to help frail seniors live in their homes.
Administered by the Executive Office of Health and Human Services (EOHHS).
Program Types
Institutional / Nursing Home Medicaid
An entitlement; anyone who is eligible will receive assistance. Benefits are provided in Medicaid-certified nursing homes.
Level of care: Nursing Home
Medicaid Waivers / Home and Community Based Services (HCBS)
Not an entitlement; there are a limited number of participant slots and waiting lists may exist. Intended to delay nursing home admissions, services are provided at home, adult day care, adult foster care, or in assisted living.
Level of care: Nursing Home
Regular Medicaid / Aged Blind and Disabled
An entitlement; meeting the eligibility guidelines ensures one will receive benefits. While Regular Medicaid is not Long-Term Care Medicaid, some long-term care services, such as personal care assistance or adult day care, may be available.
Level of care: Help with ADLs
2026 Massachusetts Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid*
Medicaid Waivers / Home and Community Based Services†
Regular Medicaid / Aged Blind and Disabled‡
*All of a beneficiary's monthly income, with the exception of a Personal Needs Allowance of $72.80 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go towards nursing home costs. This is called a Patient Liability.
†Based on one's living setting, a beneficiary may not be able to keep monthly income up to this level.
‡Another pathway to Medicaid eligibility is through SSI. In Massachusetts, persons eligible for SSI are automatically approved for Regular Medicaid, including long-term services and supports given functional criteria are met.
Explore Massachusetts Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Massachusetts.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — Massachusetts
How the main LTC programs available in Massachusetts compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $18–22/hr | Hourly wage | No | Usually no | No |
| Structured Family Caregiving (SFC) | $50–65/day | Daily stipend | Yes | Usually no | No |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
Massachusetts Medicaid programs
MassHealth HCBS Waiver
Adult Foster Care (SFC)
PCA Program
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in Massachusetts
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Structured Family Caregiving (SFC) — tax-free daily stipend
Available in MassachusettsHow to enroll: Contact Careforth (careforth.com) or FreedomCare (freedomcare.com) — both operate in Massachusetts and handle enrollment at no charge.
Consumer-directed care — hourly pay
Available in MassachusettsHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: MassHealth · mass.gov/masshealth
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in Massachusetts
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Massachusetts. The process typically takes 45–90 days from application to first paycheck.
Apply in Massachusetts: MassHealth · mass.gov/masshealth
Medicaid Eligibility Screener — Massachusetts
Answer 7 quick questions — we'll check the financial and care requirements for Massachusetts and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly any income from any source is counted, including employment wages, alimony, pension payments, SSDI, SSI, IRA withdrawals, and stock dividends.
- Nationally, Holocaust restitution payments are not counted as income.
- In MA, VA Aid & Attendance and Housebound benefits, which are above and beyond the Basic VA Pension, do not count.
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,643.75 (eff. 7/1/25 – 6/30/26). If a non-applicant's income falls under this amount, income can be transferred from the applicant spouse.
- A non-applicant spouse can increase their Spousal Income Allowance if housing/utility costs exceed a shelter standard of $793.13 / month (eff. 7/1/25 – 6/30/26), up to a Maximum MMMNA of $4,066.50 / month.
- MA is unique: the MMMNA is NOT extended to a non-applicant spouse of a Medicaid Waiver applicant, because the state does not require the applicant to pay a 'patient paid amount' towards care costs.
- For Regular Medicaid, both spouses' income is counted. There is no Spousal Income Allowance for a non-applicant spouse.
- SSI recipients are automatically approved for Regular Medicaid in Massachusetts.
- Countable assets include cash, stocks, bonds, investments, cryptocurrency, bank accounts (money market, savings, checking), and real estate in which one does not reside.
- In Massachusetts, IRAs are counted as assets.
- Non-countable (exempt) assets include personal belongings, household furnishings, an automobile, burial spaces for the applicant and immediate family members, and generally one's primary home.
- All assets of a married couple are considered jointly owned regardless of the Medicaid program.
- The CSRA allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660 (2026). If the non-applicant's share is under $32,532, up to $32,532 can be retained.
- There is no CSRA for Regular Medicaid.
- The home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.
- If this is not the case, there is a home equity interest limit of $1,097,000 (in 2026) — Massachusetts uses the higher federal option.
- Home equity is the value of the home minus any outstanding debt. Equity interest is the amount of equity owned by the applicant.
- If neither the applicant nor qualifying family live in the home, the applicant must have Intent to Return.
- There is no home equity interest limit for Regular Medicaid.
- The home is NOT exempt from Medicaid's Estate Recovery Program. After a beneficiary's death, Massachusetts' Medicaid agency attempts reimbursement of care costs through the deceased's estate.
- Massachusetts has a 5-year (60-month) Look-Back Period for Nursing Home Medicaid and Medicaid Waiver applications.
- During the look-back, the Medicaid agency checks to ensure no assets were gifted or sold for under fair market value.
- Violations result in a period of Medicaid ineligibility.
- There is no Look-Back Period for Regular Medicaid.
- The U.S. Federal Gift Tax Rule ($19,000 per recipient in 2026) does not extend to Medicaid eligibility — gifting under this rule still violates the Look-Back Period.
- MMMNA: $2,643.75 · CSRA: $162,660 · CSRA Min: $32,532
- When only one spouse applies for Nursing Home Medicaid, only the applicant's income is counted.
- The MMMNA is $2,643.75 (eff. 7/1/25 – 6/30/26). Income can be transferred from the applicant spouse if the non-applicant's income is below this level.
- A non-applicant can increase their Spousal Income Allowance if housing/utility costs exceed the shelter standard of $793.13 / month, up to a maximum of $4,066.50 / month.
- Unique to MA: the MMMNA does NOT apply to Medicaid Waiver applicants, since the state does not require a 'patient paid amount' towards care costs for waiver beneficiaries.
- The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (min $32,532) in 2026.
- For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.
- Medically Needy Pathway — Massachusetts has a Spend-Down Program for seniors over the income limit. The MNIL is $522 / month (individual) and $650 / month (couple). The spend-down is calculated for a 6-month period. The medically needy asset limit is $2,000 (individual) and $3,000 (couple).
- Asset Spend-Down — Spend excess assets on non-countable items such as home modifications (wheelchair ramps, roll-in showers, stair lifts), prepaying funeral/burial expenses, and paying off credit card and mortgage debt. Keep documentation as proof the Look-Back Rule was not violated.
- Medicaid Planning — Work with a Medicaid Planning Professional to employ strategies to become eligible and protect your home from Medicaid's Estate Recovery Program.
Massachusetts does not use Qualified Income Trusts (Miller Trusts). The Medically Needy Pathway is available for persons over the income limit.
Massachusetts Medicaid Programs
Frail Elder Home & Community-Based Services Waiver (FEW)
A variety of supports provided at home, in adult foster care homes, and in congregate housing for nursing home qualified persons, including those with Alzheimer's and related dementias. Benefits may include personal care assistance, homemaker services, home modifications, meal delivery, and personal emergency response systems.
Adult Day Health Care (ADH) Program
Daytime supervision and care, including skilled nursing, in adult day care centers across the state. Can serve as respite care for informal caregivers.
Personal Care Attendant (PCA) Program
Pays for an in-home personal care provider for a defined number of hours. Beneficiaries can hire an attendant of their choosing, including select family members such as adult children.
Enhanced Adult Foster Care / Caregiver Homes Program (AFC)
Helps individuals who require assistance with daily living activities to reside in a loved one's home and compensates the loved one for providing care.
Group Adult Foster Care (GAFC) & SSI-G
A combination MassHealth and state-funded program that pays for assisted living type care.
Senior Care Options (SCO) Program
Designed for persons who are 'dual eligible' (eligible for both Medicaid and Medicare), but seniors do not have to be on Medicare to participate in this managed care program.
Program of All-Inclusive Care for the Elderly (PACE)
Combines Medicaid (including long-term care) and Medicare benefits into one program. Additional benefits such as dental and eye care may be available.
Moving Forward Plan – Community Living (MFP-CL) Waiver
Helps nursing home residents transition back to living at home or the home of a loved one.
Moving Forward Plan – Residential Supports (MFP-RS) Waiver
Helps nursing home residents transition to assisted living or memory care residences.
Money Follows the Person
A federal program that helps institutionalized Medicaid-eligible persons transition back home or into the community.
How to Apply
- Complete and submit the Application for Health Coverage for Seniors and People Needing Long-Term Care Services online
- Download and print the application, then fax to MassHealth Enrollment Center at 617-887-8799
- Mail to MassHealth Enrollment Center, Central Processing Unit, P.O. Box 290794, Charlestown, MA 02129-0214
- Apply in person at any of the seven enrollment centers
- Call the MassHealth Customer Service Center at 1-800-841-2900 or contact a local Area Agency on Aging for assistance
Before submitting a MassHealth application, it is vital that seniors are confident they meet all eligibility requirements. Medicaid Planning can be very instrumental for those unsure of eligibility.
More Massachusetts Long-Term Care Resources
Massachusetts Long-Term Care Costs
Compare assisted living, home care, and nursing home costs.
Massachusetts Senior Services Directory
Find local aging agencies, support programs, and community resources.
Veterans Long-Term Care Benefits
Aid & Attendance, caregiver programs, and VA nursing home coverage.
Take the Next Step for Massachusetts Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- Executive Office of Health and Human Services (EOHHS) — Massachusetts Medicaid — Official site