What is an HCBS waiver under MassHealth?

On Behalf of | Dec 15, 2023 | MassHealth

Caring for an elderly and infirm loved one in Massachusetts can be draining personally and financially. People who have conditions, illnesses or are simply becoming too frail to live on their own will often need help to ensure they are properly taken care of. To address the costs for these services, many people need to apply for MassHealth.

There are frequent concerns about finances. Much of that centers on people who might not be eligible for coverage. In some cases, people can seek a waiver for seniors and disabled people to live in their community rather than be transferred to a facility and still get approved for benefits. The Home and Community Based Waiver – shortened to HCBS – can be beneficial for many who are confronted by this issue.

Know how to receive an HCBS waiver

Under MassHealth, there are two categories that are assessed to determine eligibility for an HCBS waiver: clinical and financial. Clinically, the person must show they need facility-type care. That means their condition would warrant an approval to be placed in an nursing home or other care facility. They must have the need for waivers every month. And they can be in the community and will be safe if they are granted the waiver.

Financially, those seeking the HCBS waiver must have an income that is below 300% of the current Supplemental Security Income Federal Benefit Rate. In 2023, it is $914. That means their income must fall below $2,742. Their assets must be worth less than $2,000. A spouse’s assets must be worth less than $148,620 for 2023.

Older people would likely seek the Frail Elder Waiver. This is for people 60 to 64 who have been classified as permanently and totally disabled. For those 65 and older, their disability is irrelevant. They can apply. The waiver services available include having someone come and serve as a homemaker, provide transportation for non-medical appointments and to have meals delivered to their home.

Many programs and options are available under MassHealth

People might not realize that they are eligible for certain programs under MassHealth. This is an area of elder law that might be confusing and difficult to navigate, leading many to give up in the face of obstacles and denials when they might be able to get approved if they keep trying. Elderly people who need care and assistance but think they earn too much and have too many assets should be cognizant of HCBS and other options that can help them.

In addition, family members who are unsure of how to provide the care and attention their family members require should also be up to date on waivers that can be used. In these cases, it is not uncommon for applications to be denied, but there are ways to use waivers and other strategies to receive MassHealth coverage.