There is a bill presently pending in the Committee on Health Care Financing of the Massachusetts State Legislature. The bill (Bill S. 517), sponsored by Senators James B. Eldridge of Acton, Massachusetts and Michael O. Moore of Millbury, Massachusetts, and other members of the General Court, would correct an eligibility problem that currently prevents many seniors from accessing certain Mass Health programs aimed at keeping individuals in the community rather than having to go into nursing homes. The programs that would be affected by this bill include the Home and Community Based Waiver (HCBW), also referred to as the Frail Elder Waiver, and the PACE program (I will summarize these programs in upcoming blogs). The goal of these programs is to provide home care, daycare, and other services to individuals whose conditions would otherwise make them eligible for nursing home care.
The individual applying for these programs cannot have income of more than $2,130 per month. But there’s a glitch. Under the current rules, if your income is even $1 more than the $2,130 per month cap, you are disqualified unless you pay a deductible (or “premium”) for these services. That amount typically exceeds $1,000 per month. Bill S. 517 solves that problem by providing that, if your monthly income exceeds the prescribed cap, you can still qualify for the programs simply by paying a monthly premium equal to your excess income. Thus, if your monthly income was $2,140 per month, your monthly premium would be $10, not the current amount of $1,000 or more. This common sense solution will allow frail elders in Massachusetts to be eligible for programs that will help them to do what they really want to do: stay at home, even as they are getting more frail.