Nursing Homes in Massachusetts
Nursing homes are an option for seniors recovering from an injury or illness and who require constant medical monitoring. Most of these seniors can’t remain in their homes on their own. Nursing homes provide comprehensive care outside of hospitalization with services like nutritional counseling, rehabilitation, recreational activities, hospice and palliative care.
In Massachusetts, seniors make up approximately 17% of the population. Roughly 32,000 of these seniors live in nursing homes. There are 364 facilities located throughout the state, and individuals who require this level of care may be able to receive services in them.
This guide provides information about the different public benefit options for paying for nursing homes or long-term care in the state. It also includes a list of additional resources seniors can turn to when covering the cost of care and a list of laws and regulations all facilities must follow to ensure the rights and quality of care of its residents.
Cost of Massachusetts Nursing Homes
The average cost of nursing homes in Massachusetts is $353 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Massachusetts?
MassHealth pays for short-term stays in nursing homes in Massachusetts for seniors who meet the income and asset eligibility requirements. The program pays for medical care, including skilled nursing, rehabilitation, IV therapy and wound care. As of December 2022, the program has enrolled approximately 1,968,385 individuals.
Massachusetts also offers a home and community-based waiver program for seniors in nursing homes who require skilled nursing but plan on returning to their homes. The Moving Forward Plan (MFP) waiver is for seniors who have been in a nursing home for at least 90 days and who are moving back into their homes or who plan to live with family.
Eligibility for Medicaid in Massachusetts
Massachusetts Medicaid has financial requirements for eligibility. As of 2023, the income of single seniors must total no more than $1,215 per month, with assets of no more than $2,000. In a two-person home with only one person applying, the income and asset limit of the nonapplicant spouse is not considered, so it doesn’t affect eligibility. When both spouses are applying, the income limit is slightly more at $1,643 per month, with assets totaling no more than $3,000.
A nonapplicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is $2,288.75 per month. This is the amount determined to prevent spousal impoverishment and to allow the nonapplicant spouse to remain in the community.
|Income Limits*||Asset Limits|
|Single Person||$1,215 per month||$2,000|
|Two-Person Household||$1,643 per month||$1,500 per applicant|
|One person applying||$2,000||$148,620 for nonapplicant|
In addition to meeting the requirements for both income and assets, candidates must also satisfy the following requirements.
- Be at least 65 years of age
- Need a nursing home level of care
- A resident of Massachusetts
- A U.S. citizen or legal alien
Applying for Medicaid in Massachusetts
There are several ways for seniors to apply for MassHealth. Individuals may fill out an application through the online MassHealth web portal or contact the main customer service number at (844) 365-1841. Seniors may fill out an application and fax the information to (617) 887-8799 or mail it to:
MassHealth Enrollment Center
P.O. Box 290794
Charlestown, MA 02129-0214
What Information You Will Need
- Proof of identity (such as a birth certificate or passport)
- Copies of Social Security numbers
- Proof of income (including retirement awards letters, tax returns and bank statements)
- Health and life insurance account numbers and copies of current bills
- Proof of U.S. citizenship
- Information on current liabilities
Additional Medicaid Support & Resources in Massachusetts
The following agencies can help seniors understand Massachusetts Medicaid and the application process. Trained counselors provide details on income and asset verification and details on the available waivers.
|Massachusetts Council on Aging||(413) 527-6425||The Massachusetts Council on Aging is a nonprofit agency that supports seniors aged 60 and over in the community. Agents provide Medicaid counseling and unbiased information on long-term care supplemental insurance plans.|
|Senior Legal Helpline||(800) 342-5297||The Senior Legal Helpline in Massachusetts provides free legal assistance to seniors and low-income individuals. Agents can help seniors determine their eligibility for the program and can provide assistance with Medicaid fraud.|
|Benefits.gov||(800) 841-2900||Benefits.gov is a federal website that details all the public benefit programs in each state. The site includes program contact information, income requirements and other eligibility information. There’s also an online inquiry that lists additional programs an individual may qualify for.|
Can You Use Medicare to Pay for Nursing Home Care in Massachusetts?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- A semiprivate room
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Massachusetts
Medicare provides some assistance to seniors in nursing homes. The following organizations help seniors explore their Medicare coverage options and connect individuals and their family members with trained counselors and agents who can answer basic questions.
|MassOptions||(800) 243-4636||MassOptions is a service provided by the Executive Office of Health and Human Services that connects seniors with local organizations and programs throughout the state. Counseling is provided for those seeking Medicare, Medicaid and private insurance. Seniors can get information on program eligibility, plan limits and premiums.|
|Commonwealth Care Alliance||(800) 610-2273||The Commonwealth Care Alliance answers questions concerning Medicare, including help navigating the different parts. Counselors can help seniors determine whether they are eligible for coverage and provide details on how to enroll. They also offer information on supplemental plans and long-term care insurance.|
|Medicare.gov||(800) 633-4227||Medicare.gov is the official federal website for Medicare. Seniors can call the 800 number to speak with agents about Medicare claims and basic information on coverage and applications. Individuals who have already been approved for Medicare can search a provider list to locate hospitals, nursing homes and providers in the area who accept Medicare as payment.|
Other Financial Assistance Options for Nursing Home Care in Massachusetts
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
|How to Apply||How It Works|
|Aid and Attendance||Learn more and apply online at va.gov.||Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care.|
|Reverse Mortgages||Learn more about your options and how to apply at ftc.gov.||If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.|
|Long-Term Care (LTC) Insurance||Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.||Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.|
Nursing Home Laws and Regulations in Massachusetts
|Licensing Requirements||Nursing homes in Massachusetts are regulated and licensed by the Department of Public Health. All nursing homes are categorized as level 1 or level 2 facilities. Level 1 facilities provide the highest level of care.|
|Staffing Requirements||All communities must employ a full-time administrator and a substitute administrator, who are licensed by the Board of Registration of Nursing Home Administrators. Sufficient staff must be available to provide at least 3.5 hours of care per resident per day.|
|Staff Training Requirements||Nursing home administrators must complete at least 40 hours of continuing education each year. All other staff must complete an approved Resident Care Assistance Course, and ongoing in-service education should be provided.|
|Admission Restrictions||Residents must have a written order from their primary care provider who deems nursing home care as medically necessary. Facilities must also have written consent of admission from the individual or a guardian, except in cases of emergency.|
|Care Planning Requirements||Within 14 days of admission, each resident must have a comprehensive care plan that details the medical, nursing, social, dietary and rehabilitation activities that meet the individual's needs. This plan must be reviewed every 90 days to keep up with residents' changing needs.|
|Dietary and Nutritional Services Requirements||At least three nutritious meals should be served per day, with no more than 15 hours between the evening meal and breakfast. Menus should be planned at least 1 week in advance, and records should be kept on file for at least 30 days.|
|Specialized Rehabilitative Services||Rehabilitation services must be available to residents who require them, either on-site or through an off-site provider. When an off-site provider is used, the nursing home must provide transportation to and from the treatments.|
|Medication and Pharmaceutical Services||Nursing homes must comply with federal and state laws regarding the handling, dispensing, administration, recording and storing of medications. Residents or their guardians must provide consent before the administration of any medications.|
|Activities Requirements||All facilities must employ a full-time activities director who plans and develops at least 20 hours of activity per week and who maintains records of individual participation. A monthly activity calendar must be posted in a conspicuous place and must include group activities and special events, including birthday and holiday parties.|
|Infection Control Requirements||Guidelines for infection and disease control are provided by the Centers for Disease Control and Prevention.|
|Medicaid Coverage||Medicaid covers the cost of medically necessary activities in Medicaid-certified facilities. Residents must cover the cost of their room and board.|
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