Most US long-term care is paid for by Medicaid, not Medicare.1 In Massachusetts, the program is called MassHealth, administered by the Executive Office of Health and Human Services (EOHHS) under a federal Section 1115 demonstration.

Three eligibility tests, in order

1. Medical eligibility

MassHealth LTC requires a clinical assessment confirming your parent meets the nursing-home level of care. Assessments are coordinated through the Aging Services Access Points (ASAPs) or directly through MassHealth depending on the program.2 ASAPs cover every Massachusetts community and are typically responsive within weeks.

2. Income

Massachusetts applies the federal income cap of 300% of the SSI federal benefit rate — approximately $2,829/month gross in 2026. The cap is updated each January.

If your parent’s gross monthly income exceeds the cap, they aren’t automatically disqualified. Massachusetts allows the use of a Qualifying Income Trust (QIT) to divert above-cap income.3

3. Assets

The applicant’s countable assets must be at or below $2,000 at the moment of application. MassHealth applies the standard federal exemptions plus the higher Massachusetts home-equity protection:

The five-year look-back

MassHealth applies the standard federal 60-month look-back to all long-term-care applications. Any uncompensated transfer in the 60 months before application generates a penalty period — a window during which the applicant is otherwise eligible but MassHealth will not pay.

The penalty math: transfer value divided by Massachusetts’s monthly penalty divisor, which reflects the average private- pay nursing-home cost in the state. The 2026 figure is approximately $13,000–$14,000/month — among the highest in the country, which means each dollar of penalty buys less time than in cheaper states. A $50,000 gift becomes roughly a 3.5–4-month penalty in Massachusetts.

The Frail Elder Waiver: Massachusetts’s main HCBS waiver

For most families, the goal is keeping the parent at home as long as possible. MassHealth operates the Frail Elder Waiver (FEW)— a §1915(c) waiver providing home- and community-based services as an alternative to nursing-home placement.5 FEW covers:

FEW has slot limits and can have waitlists. Apply early even if your parent isn’t yet at clinical-eligibility thresholds. There’s also a separate Personal Care Attendant (PCA) programfor consumer-directed personal care, available to MassHealth members with substantial ADL needs — PCA can pay an adult child as a caregiver.

The community-spouse situation

If one spouse needs care and the other doesn’t, the rules become more favorable. The community spouse keeps:

Massachusetts also offers the “snapshot date” approach for community-spouse calculations — assets are evaluated as of the date the institutionalized spouse is first hospitalized or admitted to a long-term-care facility, which can affect the math.

MassHealth estate recovery

Massachusetts pursues estate recovery for MassHealth LTC services paid on behalf of a recipient age 55 or older. Recovery is generally limited to the probate estate — meaning assets held in properly-structured trusts or passing by beneficiary designation can escape recovery.6 Massachusetts is more aggressive than some states in pursuing recovery, including against the home if it’s a probate asset. A Massachusetts elder-law attorney can review the estate structure to understand exposure.

What to do this month

For the broader Medicaid context, see our Medicaid pillar overview. For Massachusetts’s legal landscape (especially the $2M estate-tax cliff), see Legal & Financial in Massachusetts.