Does MassHealth Cover Nursing Homes? Eligibility, Costs, Look-Back

Yes. MassHealth, the Massachusetts Medicaid program, does cover nursing homes, and for most families it is the only realistic way to pay for a long stay. It covers room, board, and nursing services in a certified nursing facility for as long as the resident continues to meet both the clinical and financial rules, paying the facility the difference between its daily rate and what the resident contributes from their own income.¹

That coverage is available under several MassHealth types, including Standard, CommonHealth, Senior Care Options, PACE, One Care, CarePlus, and Family Assistance. Members in an Accountable Care Organization or Managed Care Organization get nursing facility coverage for the first 100 days of an admission, then are typically transitioned to MassHealth fee-for-service to continue the benefit.² Federal law also requires nursing homes to treat MassHealth residents the same as privately paying ones, and bars facilities from requiring a third party to guarantee payment as a condition of admission.¹

Why MassHealth, Not Medicare, Pays for a Long Stay

Families often arrive at this question because Medicare has run out or is about to. Medicare only covers short-term skilled nursing care after a qualifying three-day inpatient hospital stay. It pays in full for the first 20 days, charges a daily copay of $209.50 in 2025 for days 21 through 100, and stops entirely after day 100. If the patient no longer needs skilled rehabilitation or nursing, coverage can end even sooner.¹

MassHealth covers the kind of care Medicare does not: long-term custodial care for people who need ongoing help with daily activities like bathing, dressing, eating, and moving around. There is no prior hospitalization requirement and no 100-day cap. Coverage continues as long as the resident still qualifies clinically and financially. The trade-off is the financial piece, which is strict.¹

Financial Eligibility

Massachusetts is a “medically needy” state, so there is no hard income cap for nursing home MassHealth. Instead, nearly all of the resident’s monthly income goes toward their care, and the real gatekeeping happens on the asset side.

The Asset Limit and What Doesn’t Count

A single applicant can have no more than $2,000 in countable assets. A married couple with both spouses in the same facility is limited to $3,000.³ Countable assets include bank accounts, stocks, IRAs, non-residence real estate, and assets in revocable trusts. Anything that isn’t specifically exempt counts.⁴

Several assets are exempt:

The primary residence, if the applicant’s home equity does not exceed $1,130,000 (2026 figure), or regardless of value if a spouse, a child under 21, or a blind or permanently disabled child lives there.³⁵
Personal property: furniture, appliances, clothing, jewelry, household items.
One vehicle of any value, if the applicant or spouse needs it.
Burial plots, certain prepaid irrevocable funeral contracts, and up to $1,500 in a separate burial fund.⁴

Protections When One Spouse Stays Home

When one spouse enters a nursing home and the other remains in the community, federal and state law protect the at-home spouse from being impoverished. The Community Spouse Resource Allowance lets the non-applicant spouse keep up to $162,660 in assets as of January 2026. If half of the couple’s combined assets falls below $32,532, the community spouse can keep everything up to that floor.³

The at-home spouse is also entitled to a Minimum Monthly Maintenance Needs Allowance, a share of the institutionalized spouse’s income that gets redirected to the community spouse. In 2026, the minimum is $2,643.75 and the maximum is $4,066.50 per month. Housing costs above 30% of the MMMNA can increase that amount through an excess shelter allowance.³

What the Resident Pays Each Month

The resident contributes nearly all of their monthly income to the nursing home. This is called the Patient Paid Amount. To calculate it, MassHealth starts with gross monthly income and subtracts, in order:

A Personal Needs Allowance of $72.80 per month for personal items like clothing, toiletries, and haircuts.
Medicare Part B premiums, which are $202.90 per month in 2026.
Medigap or other health insurance premiums.
Any income diverted to a community spouse to reach the MMMNA.
Court-ordered family support and approved uncovered medical expenses, if applicable.⁶

Whatever is left is paid to the facility. MassHealth covers the gap between that amount and the facility’s daily rate. The $72.80 Personal Needs Allowance has not been raised since fiscal year 2008. Bills pending in the Massachusetts legislature (S.887, S.482, and H.1411) would increase it to at least $100 per month and tie future increases to inflation. As of mid-2026, S.887 has been reported favorably from committee to Senate Ways and Means, while H.1411 remains in the Joint Committee on Health Care Financing with a reporting deadline of July 31, 2026.⁷⁸

Clinical Eligibility

Money is only half of it. MassHealth also requires a clinical determination that the applicant needs a nursing facility level of care. A nurse from an Aging Service Access Point or a discharging hospital does the assessment under 130 CMR 456.409.⁹

An applicant qualifies clinically under one of two standards. The first is a need for at least one daily skilled service performed by or under the supervision of a registered nurse or therapist: IV feeding, wound care for deep ulcers, oxygen administration, catheter care, or skilled nursing observation of an unstable condition. The second is a combination of at least three needs drawn from Activities of Daily Living (bathing, dressing, toileting, transferring, mobility, eating) and nursing services (medication monitoring, vital signs observation, behavior intervention, physician-ordered therapies), with at least one being a nursing service.⁹

The Five-Year Look-Back on Gifts and Transfers

MassHealth reviews financial transactions for the 60 months before the application date. Any transfer of assets for less than fair market value during that window can trigger a penalty period of ineligibility. That includes gifts for birthdays, weddings, tuition, or down payments, and even transfers that fall within the federal gift-tax annual exclusion.¹⁰

The penalty is the total value of disqualifying transfers divided by a daily divisor. For November 1, 2025, through October 31, 2026, that divisor is $450 per day.¹¹ A $90,000 gift inside the look-back window produces 200 days of ineligibility. The penalty clock doesn’t begin running until the applicant is otherwise eligible, meaning they’re already in a nursing home and have spent down to $2,000. Returning the transferred asset eliminates the penalty.¹⁰

Some transfers are exempt from penalty:

Transfers to a spouse.
Transfers to a blind or disabled child, or to a trust for a disabled individual.
Transfers of the home to a child under 21.
Transfers of the home to a sibling with an equity interest who lived there for at least one year before the applicant’s admission.
Transfers of the home to a “caretaker child” who lived there for at least two years before admission and provided care that delayed the need for nursing home placement.¹⁰

How To Apply

Applications use the SACA-2 form, “Application for Health Coverage for Seniors and People Needing Long-Term-Care Services,” together with the Long-Term Care Supplement (Supplement A, beginning on page 25).¹²

You will need proof of income, assets, citizenship or immigration status, health insurance, and Social Security numbers for household members. For nursing home applicants, MassHealth also requires bank and investment statements for the full 60-month look-back, along with copies of every check of $1,000 or more written during that period. Massachusetts law bars banks from charging for records requested in connection with a MassHealth application.¹³ If a spouse lives at home, the supplement also asks for the current property tax bill, mortgage payment, home insurance premium, and a recent utility bill.

You can file online through an Adobe e-signature portal (though it has to be completed in one sitting), by mail or fax to the MassHealth Enrollment Center in Charlestown, or in person at Enrollment Centers in Charlestown, Chelsea, Springfield, Taunton, Tewksbury, Quincy, or Worcester.¹² MassHealth customer service is (800) 841-2900, Monday through Friday, 8 a.m. to 5 p.m.

Federal rules require a response within 45 days, or 90 days if a disability determination is involved. Processing often takes closer to three months in practice.¹⁴ If MassHealth needs more information it sends a request by mail, and missing the deadline can mean denial and starting over.¹⁵

If the Goal Is To Stay Out of a Nursing Home

MassHealth also funds several programs built to keep people in their own homes or in community settings. These use the same financial rules as nursing home coverage (income below 300% of the SSI Federal Benefit Rate, or $2,982 per month, and assets below $2,000 for individuals), and the applicant still has to clinically qualify as needing a nursing facility level of care.¹⁶

The Frail Elder Waiver serves residents 60 and older who would otherwise need a nursing home. It covers personal care, homemaker services, respite care, home modifications like wheelchair ramps, medication dispensing systems, and transitional help for people moving out of a facility. The waiver is not an entitlement, so there can be waitlists.¹⁷

The PACE program (Program of All-Inclusive Care for the Elderly) serves people 55 and older through an interdisciplinary care team, with the explicit goal of keeping participants living at home.² Senior Care Options is a managed care program for people with both Medicare and MassHealth that coordinates medical and long-term care services. As of January 1, 2026, SCO enrollment requires both Medicare Parts A and B along with MassHealth Standard; members without Medicare were moved to MassHealth fee-for-service.¹⁸

One boundary worth knowing: MassHealth does not cover room and board in assisted living residences. The Group Adult Foster Care program pays for personal care services for MassHealth members in GAFC-certified assisted living facilities, but room and board has to be covered separately. People receiving SSI may qualify for a state supplement (SSI-G) to help. Not every assisted living residence is GAFC-certified, so verify before relying on this.¹⁹

What Happens to the House and Estate After Death

After a MassHealth nursing home resident dies, the state can seek reimbursement from the deceased person’s probate estate for the cost of long-term care it paid. This is the Medicaid Estate Recovery Program. Recovery is limited to probate assets: property, vehicles, and bank accounts owned solely by the person at death. Assets outside probate, including properly structured trusts and jointly owned property that passes by right of survivorship, are not subject to recovery.²⁰

Massachusetts narrowed its estate recovery program significantly through Chapter 197 of the Acts of 2024, signed by Governor Maura Healey on September 6, 2024. Previously, the state pursued reimbursement for all MassHealth services provided after a member turned 55. Under the new law, which applies to deaths on or after August 1, 2024, recovery is limited to the federal minimum: nursing home care and home- and community-based waiver services for members 55 and older. The law also ended estate recovery for people with disabilities covered through CommonHealth.²¹

Several exemptions and deferrals apply. Estates of $25,000 or less are automatically exempt. Recovery is deferred if the deceased is survived by a spouse, a child under 21, or a blind or permanently disabled child. Hardship waivers are available in specific situations, including when an heir provided live-in care for two years before the nursing home admission or when an heir’s income falls below certain poverty thresholds. Claims must be filed within three years of the date of death, and unpaid balances can accrue 12% annual interest.²²

1
Mass.gov. Paying for a Stay in a Nursing or Rest Home
2
Mass.gov. MassHealth Nursing Facility Coverage Types
3
Mass.gov. Program Financial Guidelines for Certain MassHealth Applicants and Members
4
MCLE. Nursing Home MassHealth Eligibility
5
Medicaid Planning Assistance. Medicaid Eligibility Massachusetts
6
Brevy. Massachusetts Medicaid Personal Needs Allowance
7
General Court of Massachusetts. S.887 – An Act Increasing the Personal Needs Allowance for Long Term Care Residents
8
General Court of Massachusetts. H.1411 – An Act Increasing the Personal Needs Allowance for Long Term Care Residents
9
Mass.gov. Long-Term Care Services
10
MassHealth Help. Summary of Medicaid Nursing Home Eligibility
11
Mass Legal Services. MassHealth Long Term Care and Resident Rights
12
Mass.gov. Apply for MassHealth Coverage for Seniors and People of Any Age Who Need Long-Term Care Services
13
Western Mass Elder Planning. MassHealth Application Instructions
14
Medicaid Long Term Care. Medicaid Pending
15
Hebrew SeniorLife. How To Apply for MassHealth When You Need Long-Term Care
16
Mass.gov. Home and Community Based Services Waivers
17
Medicaid Planning Assistance. MassHealth Frail Elder Waiver
18
Mass.gov. 2026 SCO Eligibility Changes
19
Medicaid Long Term Care. Medicaid Eligibility Massachusetts
20
Mass.gov. Massachusetts Medicaid Estate Recovery
21
Mass Legal Resource Institute. Massachusetts Long-Term Care Bill Signed Into Law
22
Massachusetts Bar Association. Medicaid Estate Recovery – The Impact of An Act to Improve Quality and Oversight of Long-Term Care