Frail Elder Waiver

I am sure there are readers out there who, like me, aren’t excited about the aging process. Most of us say, “well if I am going to age, I want it to be in my house, not in a home or facility.”

That is fine if you can take care of yourself until the end. But if your care needs at home increase dramatically and family members cannot provide such care then how do you get it? Not through federal Medicare coverage. You get the care either by spending your savings or through Masshealth aka Medicaid. But Medicaid has rigid asset and income ceilings that disqualify many elders from standard coverage.

There is, however, a program that is gaining ground known as the “Frail Elder Waiver”. The “waiver” is where Masshealth essentially says “we are going to waive the usual requirements if you meet these other criteria”. Here are the important criteria. The applicant must be at least 60 years old, require the level of care provided by a nursing home, must have less than $2,000 in assets and income of less than $2,199 per month. In the case of a married applicant the income of the spouse is not considered. However, the spouse is only allowed a maximum of $121,200 in savings. The spouse and/or applicant can also own a home.

There are strategies that an experienced, knowledgeable elder law attorney can advise you on to try to make you eligible even if you or your spouses’ assets exceed the limits noted above. Some of these strategies are aggressive and sophisticated. Applicants are able to transfer funds out of their name to get below $2,000. Any such transfers/gifts within the prior 5 years must be disclosed on the waiver application even though it won’t disqualify the applicant. HOWEVER, you must be mindful that there is a distinct possibility that the elder/applicant may later need a nursing home. At that time the asset transfer WILL make the elder ineligible for nursing home coverage. So be careful. It makes no sense that the rules for the waiver program vary from nursing home coverage but that’s the way it is.

I recommend that frail elders become clients of Highland Valley Elder Services in Northampton. HVES is the organization tasked with the job of clinically screening appropriate Waiver applicants. The following are some of the services you can access through the Waiver program: Adult day care, Home health Aide, Personal Care, Respite care for the primary or family caregiver and transportation assistance.

The Frail Elder Waiver can be a marvelous way to access government funding for care in the home so that an elder can avoid and/or stave off a long-term care placement. However, as with any needs-based government program, you must be careful about what you do with your assets (including your house) and how a course of action interrelates with estate planning issues such as capital gains taxes, Wills, probate avoidance, Trusts, asset ownership/survivorship, family dynamics and the like.