Six Tips for Sailing Through the MassHealth Application Process

By Julie L. Dyer

1.  Hire an elder law attorney. No seriously do it. I know it may sound corny for us to write this,  but I can tell you we’ve seen so many horror stories from people that tried to navigate the MassHealth labyrinth on their own. It is a long arduous process that can beat down the average person and we do it here all the time. We and other elder law offices have forged relationships with the caseworkers and can often cut crises off at the pass. Hire an elder law attorney. You’ll be so glad you did, you could actually blog about it!

2.  Keep organized records. Some people have four bank accounts; one of our clients had more than 50.  (I’m not kidding.) It is so important during this process to stay on top of all of your or your parent’s accounts, pensions, annuities, health insurance premiums, homeowner’s insurance policies, etc. Caseworkers at MassHealth can ask you to verify a deposit or expense up to five years in the past (and they will), so start now. Keep records and create a good filing system.

3.  Find a nursing home you like. This is often the hardest step in the process. You are coming to the realization that your family member can’t stay at home and get the care he or she needs.  Try to find a facility that will provide good care and where you will feel comfortable visiting. Also, if possible, talk to the staff, not just the administration, since they will be the ones actually caring for your loved one. Write a checklist of the care your family member needs and ask the administration how those needs will be satisfied. Also, ask if they accept MassHealth, since if not you’ll need to continue your search.

4.  Be friendly at your bank. Getting bank records can be one of the hardest parts of the process and often they don’t really want to help you or work with you. Would you want to go through your systems and print out 60 months of statements and copies of all checks? If you forge a relationship with the bank staff and they know your and your parents’ situation, they are more likely to be sympathetic and helpful. Treat them like people, not simply clerks pushing paper, and they’re likely to treat you the same way. It could make all the difference come application time. 

5.  Stop having taxes taken out of pensions and other income. If your family member is, or plans to be, receiving MassHealth benefits, she will be responsible for contributing the majority of their income to the cost of long-term care. This is called the Patient Pay Amount (“PPA”).  MassHealth requires that this be paid to the nursing home and does not care that it’s being withheld to pay taxes. Further, since the payment to the nursing home is deductible as a medical expense, it’s unlikely that any income taxes will have to be paid going forward in any event. 

6.  Do NOT give money away. MassHealth has a 60 month look-back period. That means if you give any money to anyone in your family during the 60 months prior to paying for benefits, they will have to return it, or you won’t be eligible for benefits.

7.  Be patient and persistent. I know I said 6 tips, but here’s another. The application process takes a long time and MassHealth asks for a lot of details and documentation. Settle in for the long haul and do your best to provide them with what they request on a timely basis. Ultimately, your family member will be approved. It just might take several months.


Julie L. Dyer is a paralegal with Margolis & Bloom who specializes in assisting clients with MassHealth applcations.

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