MassHealth Frail Elder Waiver Program Explained

The MassHealth Frail Elder Waiver Program is a vital resource for seniors in Massachusetts who need ongoing care and support.

This program allows eligible individuals to receive care and services in their own homes, rather than in a nursing home, which can be a more costly and restrictive option.

The program is designed for individuals who are at risk of needing nursing home care, but with the right support, can remain safely in their own homes.

The goal of the program is to provide the necessary support and services to help individuals maintain their independence and quality of life.

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The MassHealth Frail Elder Waiver is a program that provides Home and Community-Based Services (HCBS) for elderly Massachusetts residents who are at risk of being institutionalized.

The Frail Elder Waiver offers a wide variety of services, including in-home personal care assistance, homemaker services, and a personal emergency response system.

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Program participants can receive services in their home, the home of a relative or caregiver, an adult foster care home, or in congregate housing. Services cannot be provided in institutional or residential settings, such as nursing home facilities, with the exclusion of short-term respite care.

The Frail Elder Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver, and Medicaid in Massachusetts is called MassHealth.

Program participants have the option to self-direct some of their services, allowing them to hire a relative or friend to provide companion and homemaker services. However, a spouse or other legally responsible person cannot be hired.

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To be eligible for the MassHealth Frail Elder Waiver, you must be at least 60 years old.

However, if you're between 60 and 64, you'll need to be physically disabled.

The cost of providing care at home must not exceed what it would cost in a nursing home.

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To be financially eligible, your income must not exceed $2,829 per month if you're single.

Married couples can each have up to $2,829 a month in income, but if only one spouse is applying, the non-applicant spouse can keep all their income.

If you have high medical expenses, you might be eligible through the Medically Needy Pathway for MassHealth, with a monthly income limit of around $522 for individuals.

Couples with high medical expenses can have a monthly income limit of around $650.

Countable assets, such as cash, bank accounts, and life insurance policies, are also considered.

Individuals can have up to $2,000 in countable assets, while married couples can have up to $4,000.

If only one spouse is applying, the non-applicant spouse can keep 50% of the couple's assets, up to $154,140.

Your primary residence is exempt from asset limits, as long as you live in it, up to an equity value of $1,071,000.

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The MassHealth Frail Elder Waiver provides a wide range of benefits and services to support seniors in living independently in their own homes.

Alzheimer's and Related Dementia Coaching is available to help individuals with dementia and their caregivers navigate successful home and community living.

Companion Services offer companionship, supervision, and minimal assistance with household tasks, such as preparing meals and doing laundry.

Education Programs are designed to help participants manage chronic conditions and improve their overall health.

The Goal Engagement Program provides individualized services to increase a program participant's safety and independence.

Grocery Shopping and Delivery services ensure that participants have access to fresh food and groceries without having to leave their homes.

Home Delivered Meals are prepared and delivered to participants' homes, providing a convenient and nutritious meal option.

Homemaker and Chore Services help with essential tasks, such as cleaning, laundry, and minor home repairs.

Home Modifications to Improve Accessibility can include wheelchair ramps, grab bars, and widening of doorways to make homes safer and more accessible.

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Home Health Aide services provide healthcare and personal care assistance to participants.

Occupational Therapy evaluates participants' home safety and independence, identifying areas for improvement.

Pre-packaged Medication Delivery ensures that participants receive their medications in a convenient and organized manner.

Personal Care services provide non-medical assistance with personal hygiene, bathing, dressing, toileting, and medication reminders.

Respite Care provides short-term care to alleviate the burden on primary caregivers.

Here is a summary of the benefits and services available through the MassHealth Frail Elder Waiver:

To apply for the MassHealth Frail Elder Waiver, you'll need to start by ensuring you meet the eligibility criteria. The American Council on Aging offers a Medicaid Eligibility Test to determine if you might meet Medicaid's eligibility criteria.

You'll need to gather documentation for submission, which can take several weeks to complete. Examples of required documents include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income.

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Applicants can apply for MassHealth online or print the Application for Health Coverage for Seniors and People Needing Long-Term Care Services. The completed application can be mailed, faxed, or dropped off at the MassHealth Enrollment Center.

A functional assessment is required as part of the application process for FEW. Persons should contact their local Aging Services Access Point (ASAP) to initiate the assessment and enroll in FEW.

If you're interested in applying for the Frail Elder Waiver, applicants can contact the MassOptions call center at 800-243-4636, or visit massoptions.org to get referred to their local Aging Service Access Point (ASAP).

Here is a list of other MassHealth programs available that help residents avoid nursing homes: