Activities of Daily Living
What does Adult Foster Care include?
Adult Foster Care provides an eligible MassHealth member with personal care and support from a qualified live-in caregiver, together with professional nursing oversight and care management.
Depending on the member’s assessed needs and plan of care, assistance may include bathing, dressing, toileting, transferring, mobility, eating, cueing, supervision, meal preparation, housekeeping, and laundry.
Mass Care Link supports enrolled members and caregivers with care planning, training, scheduled visits, and ongoing coordination. Learn more on our Adult Foster Care service page.
This information is general and educational. Services and authorization depend on current requirements, assessed needs, and the individual plan of care.
Adult Foster Care
What Is MassHealth Adult Foster Care?
MassHealth Adult Foster Care is a home-based program for eligible MassHealth members who need daily physical assistance or cueing and supervision with at least one qualifying activity of daily living.
The member lives with a qualified caregiver who provides personal care and support. The program also includes professional nursing oversight, care management, caregiver training, and an individualized plan of care.
Coverage alone does not guarantee approval. Read our complete Massachusetts Adult Foster Care guide.
Official sources: MassHealth program fact sheet and 130 CMR 408.000.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
You can also learn who may need caregiver services.
Is there anything I can do to help speed up the Adult Foster Care application process?
Yes. Families can help prevent avoidable delays by responding promptly and providing complete, accurate information.
- Complete the application and requested forms promptly.
- Provide current MassHealth and caregiver information.
- Submit requested medical documentation, including a current physical examination when required.
- Be available for the member, caregiver, and home assessments.
- Respond quickly when the intake team requests clarification or additional documents.
MassHealth authorization and third-party records are not controlled by Mass Care Link, so no approval date can be guaranteed. Review what happens after applying, or begin with our prequalification questions.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
How long does it take to be approved for Adult Foster Care services?
There is no single guaranteed approval timeline. Timing depends on how quickly the application, medical records, physical examination, assessments, caregiver documentation, and MassHealth authorization are completed.
Applicants can help avoid unnecessary delays by submitting complete information, remaining available for assessments, and responding promptly to requests. Final authorization depends on MassHealth.
See our guide explaining what happens after you apply.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
Does MassHealth pay for home care?
Yes. MassHealth covers several home- and community-based services for eligible members, depending on the person’s coverage, clinical needs, and program requirements.
One option is Adult Foster Care, which allows an eligible MassHealth member to receive daily personal care from a qualified live-in caregiver, together with nursing oversight and care management. The caregiver may be a family member, except for certain excluded relationships such as a spouse or legal guardian.
MassHealth also covers certain home health services, such as skilled nursing, medication administration, therapy, and home health aide services when applicable medical-necessity and authorization requirements are met.
Because the right program depends on the individual’s needs and coverage, families should review their specific situation before assuming one type of home-care service applies. Learn more about Adult Foster Care in Massachusetts.
How do I become a paid caregiver for a family member in Massachusetts?
You may be able to receive a caregiver payment through Massachusetts Adult Foster Care when both the person receiving care and the caregiver meet the applicable requirements.
The person receiving care generally must be at least age 16, have qualifying MassHealth coverage, need daily physical assistance or cueing and supervision with at least one qualifying activity of daily living, and be able to receive care safely in an approved home setting.
The caregiver generally must be at least age 18, live with the person receiving care, satisfy the provider’s approval requirements, and not be the member’s spouse or court-appointed legal guardian. A parent cannot be the paid caregiver for a child under age 18.
Learn more in our family caregiver payment guide, complete the prequalification questions, or call 866-880-8889.
This information is general and educational. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
What does Adult Foster Care include?
Adult Foster Care provides an eligible MassHealth member with personal care and support from a qualified live-in caregiver, together with professional nursing oversight and care management.
Depending on the member’s assessed needs and plan of care, assistance may include bathing, dressing, toileting, transferring, mobility, eating, cueing, supervision, meal preparation, housekeeping, and laundry.
Mass Care Link supports enrolled members and caregivers with care planning, training, scheduled visits, and ongoing coordination. Learn more on our Adult Foster Care service page.
This information is general and educational. Services and authorization depend on current requirements, assessed needs, and the individual plan of care.
Can an Adult Foster Care member stay home alone while the caregiver is at work or school?
Whether a member can safely remain home alone depends on the member’s assessed needs, required supervision, and individual plan of care.
The caregiver must ensure that the assistance and supervision required by the care plan are available. If the member requires continuous supervision or cannot safely be left alone, appropriate care arrangements must be made. Work, school, or time away from home cannot interfere with the caregiver’s approved responsibilities.
Families should discuss the proposed schedule with their Adult Foster Care provider. Learn more about qualification and care requirements.
This information is general and educational. Caregiver approval and service requirements depend on the member’s assessed needs and individual circumstances.
Application Process
Is there anything I can do to help speed up the Adult Foster Care application process?
Yes. Families can help prevent avoidable delays by responding promptly and providing complete, accurate information.
- Complete the application and requested forms promptly.
- Provide current MassHealth and caregiver information.
- Submit requested medical documentation, including a current physical examination when required.
- Be available for the member, caregiver, and home assessments.
- Respond quickly when the intake team requests clarification or additional documents.
MassHealth authorization and third-party records are not controlled by Mass Care Link, so no approval date can be guaranteed. Review what happens after applying, or begin with our prequalification questions.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
How long does it take to be approved for Adult Foster Care services?
There is no single guaranteed approval timeline. Timing depends on how quickly the application, medical records, physical examination, assessments, caregiver documentation, and MassHealth authorization are completed.
Applicants can help avoid unnecessary delays by submitting complete information, remaining available for assessments, and responding promptly to requests. Final authorization depends on MassHealth.
See our guide explaining what happens after you apply.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
Autism
What is autism spectrum disorder(ASD)?
According to HHS.gov, Autism Spectrum Disorder (ASD) is a developmental disability. People with ASD may communicate and interact in ways that are different from most other people. ASD includes what the American Psychiatric Association used to call autistic disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified. ASD is called a “spectrum” disorder because people with ASD can have a range of strengths and challenges, and need more or less support for those challenges. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some children and adults with ASD need a lot of assistance in their daily lives; others need less.
Caregiver
Who Can Be a PCA for a Family Member in Massachusetts?
Family members may be able to work as a Personal Care Attendant (PCA) for an eligible MassHealth member in Massachusetts, subject to PCA program requirements.
The PCA program is consumer-directed, meaning the MassHealth member receiving services, or their designated representative when applicable, is responsible for directing the PCA’s work.
Eligible PCAs may include certain adult family members, such as adult children, siblings, grandchildren, nieces, nephews, or other qualified individuals.
The rules for who may serve as a PCA are different from the rules for Adult Foster Care, so families should review the requirements of the specific program they are considering.
How do I become a caregiver in Massachusetts?
A prospective Adult Foster Care caregiver generally must be at least age 18, live in the same qualified home as the person receiving care, be capable of providing the required personal care and supervision, and complete the provider’s screening, documentation, training, and approval process.
The caregiver cannot be the member’s spouse or court-appointed legal guardian. A parent cannot be the paid caregiver for a child under age 18. The person receiving care must separately satisfy the applicable MassHealth coverage and clinical requirements.
Read how to qualify and how caregiver payments work.
This information is general and educational. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
Review the typical roles and responsibilities of a family caregiver.
How much does Mass Care Link pay?
An approved Mass Care Link family caregiver may receive up to $1,520 per month, based on need and MassHealth approval. The amount is not automatic and may be lower depending on the member’s assessed needs and authorization.
Payment begins only after eligibility, caregiver approval, authorization, and placement requirements are completed. Read our detailed guide: How Much Do Family Caregivers Get Paid in Massachusetts?
This information is general and educational. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
Can I get paid to take care of a family member?
Possibly. A qualified adult may be paid to care for an eligible family member through Massachusetts Adult Foster Care when the member, caregiver, and living arrangement satisfy all applicable requirements.
The caregiver cannot be the member’s spouse or court-appointed legal guardian. A parent cannot be the paid caregiver for a child under age 18, but may potentially qualify when caring for an adult child age 18 or older. The caregiver and member must live together.
Learn more in our family caregiver payment guide or complete the prequalification questions.
This information is general and educational. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
Is Mass Care Link accredited by an accrediting committee to ensure quality of services?
How are caregivers paid?
Approved Mass Care Link caregivers may select an available payment method during onboarding, such as direct deposit or a mailed check. The team explains the payment schedule, documentation responsibilities, and available options before services begin.
Payment starts only after the required approval, authorization, and placement steps are completed. Learn more in our Massachusetts caregiver payment guide.
This information is general and educational. Caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
Caregiver Payment
How do I become a paid caregiver for a family member in Massachusetts?
You may be able to receive a caregiver payment through Massachusetts Adult Foster Care when both the person receiving care and the caregiver meet the applicable requirements.
The person receiving care generally must be at least age 16, have qualifying MassHealth coverage, need daily physical assistance or cueing and supervision with at least one qualifying activity of daily living, and be able to receive care safely in an approved home setting.
The caregiver generally must be at least age 18, live with the person receiving care, satisfy the provider’s approval requirements, and not be the member’s spouse or court-appointed legal guardian. A parent cannot be the paid caregiver for a child under age 18.
Learn more in our family caregiver payment guide, complete the prequalification questions, or call 866-880-8889.
This information is general and educational. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
Eligibility
How do I appeal a MassHealth decision?
If you disagree with a MassHealth decision, you may have the right to request an appeal through the MassHealth fair-hearing process. Carefully review the notice because it should explain the decision, appeal rights, filing instructions, and applicable deadline.
Visit the official Mass.gov page, How to appeal a MassHealth decision, for current instructions and forms. You may also call MassHealth at 800-841-2900 or TDD/TTY 711.
Mass Care Link cannot file an appeal on your behalf or provide legal advice about a MassHealth decision. Because deadlines may apply, review the notice and contact MassHealth promptly.
Would I be able to receive payment for taking care of son/daughter with autism?
A parent caring for a son or daughter with autism may potentially qualify for caregiver payment when the child is age 18 or older and all Adult Foster Care requirements are met. An autism diagnosis by itself does not establish eligibility.
The person receiving care generally must have qualifying MassHealth coverage and need daily physical assistance or cueing and supervision with at least one qualifying activity of daily living. A parent cannot be the paid caregiver through this program for a child under age 18. For an eligible member age 16 or 17, another qualified adult who is not the parent or legal guardian may potentially serve as caregiver.
Read about caring for a disabled adult child or complete the prequalification questions.
This information is general and educational. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
What are my options if do not qualify for adult foster care services?
If a person does not qualify for Adult Foster Care, other programs or community services may still be available depending on age, disability, MassHealth coverage, location, and care needs.
Possible resources may include Personal Care Attendant services, home-care programs, aging-services resources, disability supports, adult day services, or other home- and community-based programs. Availability and eligibility vary.
Review the Commonwealth’s caregiving resources or contact MassHealth at 800-841-2900. You can also compare programs in our caregiver-program guide.
What are the required physical aspects of the home?
- The AFC home must be clean, in good repair, and provide for normal comforts in accordance with accepted community standards.
- The home must have at least one smoke detector and carbon monoxide detector on each floor and at least one approved fire extinguisher serviced annually.
- The AFC home will have at least one adequately supplied first aid kit.
- The home will pass an initial home safety screening; any outstanding issues will be corrected prior to participant moving in.
- Each participant will have his/her own bedroom. Bedrooms should have a source of natural light with a screened window that opens.
- Closet and dresser space must be provided within the bedroom for the participant’s personal possessions and for a reasonable degree of privacy
Can I received a monthly payment for taking care of someone at home?
Do caregivers have to live together with the person receiving care?
Yes. The Adult Foster Care member and primary caregiver must live together in the same approved or qualified home setting. They may already share a home, or one may move into the other’s home before services begin.
The residence must also satisfy applicable program requirements. Read our qualification guide.
This information is general and educational. Eligibility and caregiver approval depend on current requirements and individual circumstances.
Do you have to reside in the state of Massachusetts to qualify for services?
Yes. Adult Foster Care through MassHealth is available to eligible Massachusetts residents. The member must reside in Massachusetts and satisfy the applicable coverage, clinical, caregiver, and living-arrangement requirements.
Mass Care Link serves eligible families throughout the Commonwealth. Review our Massachusetts qualification guide or complete the prequalification questions.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
Can a spouse be the caregiver?
No. A spouse cannot serve as the paid Adult Foster Care caregiver for their spouse under Massachusetts program rules.
Another qualified adult who is at least age 18, lives in the home, is not the member’s court-appointed legal guardian, and satisfies all caregiver requirements may potentially be approved. The member must also satisfy the applicable MassHealth coverage and clinical requirements.
See our qualification guide.
This information is general and educational. Eligibility and caregiver approval depend on current requirements and individual circumstances.
What are the caregiver’s necessary qualifications?
An Adult Foster Care caregiver generally must:
- Be at least age 18.
- Live in the same qualified home as the member.
- Be able to provide the personal care, cueing, supervision, and other assistance required by the member’s plan of care.
- Complete required screening, references, health documentation, training, and provider approval.
- Not be the member’s spouse or court-appointed legal guardian.
A parent cannot be the paid caregiver for a child under age 18. Requirements are reviewed individually. Learn more in our caregiver qualification guide.
This information is general and educational. Caregiver approval depends on current requirements and individual circumstances.
Are members and caregivers required to live together?
Yes. An Adult Foster Care member and caregiver must reside together in the same qualified home setting. The requirement allows the caregiver to provide the daily assistance and supervision established in the member’s individual plan of care.
This does not mean every member automatically requires continuous one-to-one supervision. The exact responsibilities depend on the member’s assessed needs and approved care plan. Learn more about Adult Foster Care services.
This information is general and educational. Service and caregiver requirements depend on current rules and individual circumstances.
What MassHealth coverage is required for Adult Foster Care in Massachusetts?
The member generally needs qualifying MassHealth coverage, such as MassHealth Standard or CommonHealth. Coverage should be verified for the individual applicant because benefit and enrollment circumstances can differ.
Qualifying coverage does not automatically establish Adult Foster Care eligibility. The member must also meet the clinical and living-arrangement requirements, and the caregiver and qualified setting must be approved.
Read our qualification guide, or call MassHealth at 800-841-2900 with questions about coverage.
Official sources: MassHealth program fact sheet and 130 CMR 408.000.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
Enrollment
How long does it take to get approved for a caregiver payment?
There is no guaranteed approval timeline for caregiver payment. Timing depends on completion of the application, assessments, medical documentation, caregiver screening, MassHealth authorization, and placement requirements.
Payment does not begin merely because an application was submitted. Families can help avoid unnecessary delays by providing complete documents and responding promptly to requests. Read what happens after applying.
This information is general and educational. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
What happens once someone is approved for adult foster care services?
After MassHealth authorization and the provider’s final enrollment steps are completed, Mass Care Link coordinates placement and onboarding with the member and caregiver.
The process may include reviewing and signing required documents, confirming the plan of care, completing caregiver training, explaining payment and documentation responsibilities, and scheduling ongoing nursing and care-management visits. Services and caregiver payment begin only after all required approvals and placement steps are complete.
Read what happens after applying for Adult Foster Care.
This information is general and educational. Eligibility, caregiver approval, payment, and authorization depend on current requirements and individual circumstances.
Health Care for Veterans
WHAT ELSE DO I NEED TO KNOW?
Not everyone who is eligible for VA health benefits needs to apply. Some veterans, such as those with certain types of disabilities, are automatically eligible to receive VA health benefits. But it can be a good idea to apply anyway.
If you have questions about VA health care benefits, including whether you are eligible, you may contact the VA by calling 1-877-222-8387. When you call this number, you can ask for the contact information for the Enrollment Coordinator at your local VA health care facility. Finally, you can also visit the VA’s health care websites, which are available at www.va.gov/healthbenefits and www.myhealth.va.gov.
How do I apply?
You can complete the application online, in person at a VA health care facility, or over the phone. The application is available online athttps://www.1010ez.med.va.gov/. If your application is accepted and you are enrolled, the VA will send you a personalized handbook that will explain the benefits you may access, and will assign you to a Priority Group. If your application is not accepted, you have the right to appeal. The VA will send you instructions on how to appeal if your application is denied.
Am I eligible for Health Health Care for Veterans in Massachusetts?
The eligibility criteria for the VA health care system are complicated. In general, you must have served in the active military, naval, air service, Reserves, or National Guard and must have been honorably discharged. However, your income, assets, and health status (including level of disability, if any) are also considered in the determination of eligibility for VA benefits. There are 8 different enrollment priority groups. Eligibility for VA health benefits varies from veteran to veteran, depending on each veteran’s unique characteristics and eligibility factors. Depending on your eligibility status, you may be eligible for free health care services, or you may be required to pay a copayment for health care you receive from the VA system. In addition, some veterans’ benefits are available to family members of veterans as well.
Health Care for Veterans
If you or your spouse served in the US armed forces, you may be eligible to receive healthcare through the Department of Veterans Affairs (“VA”). The VA provides a comprehensive health care system with a wide range of benefits. The VA health care system will not change when the Affordable Care Act comes into effect in January 2014.
Legal Guardianship
What should I do if I need free legal assistance to file a legal guardianship?
Contact the Eastern Region Legal Intake (ERLI) line at 617-603-1700. ERLI will conduct a telephone intake and can provide legal advice or make appropriate referrals.
Can a legal guardian make medical decisions for the incapacitated person?
Legal guardians have the authority to make general medical decisions for the incapacitated person. Guardians may generally consent to routine, noninvasive, non-experimental treatments for the incapacitated person.
Guardians must seek specific authority from the Court to administer antipsychotic medication to the incapacitated person, or for other extraordinary medical authority. A guardian is obligated to act in the best interest of the incapacitated person.
The power to commit the incapacitated person to a mental health or nursing facility requires special court proceedings in the district court.
How much does it cost to petition for guardianship?
There is no filing fee for a guardianship petition. The petitioner must pay for the cost of providing notice to all interested parties, which sometimes requires service by publication in a newspaper selected by the Court. There is a $75 filing fee for a bond with sureties. The Court will not generally require a bond with sureties. Certified Letters of Appointment cost $25 each. A guardian who cannot afford to pay the fees can ask the Court to waive the fees by filing an Affidavit of Indigency.
How can a person become a legal guardian?
A petitioner must complete and file numerous court documents and appear at a hearing to be appointed as guardian. A petition for guardianship must be filed by anyone seeking guardianship.
A petition for guardianship must be accompanied by Medical Documentation. In a case where the incapacitated person has a clinically diagnosed intellectual disability, a clinical team report is required. This report must be signed by a physician, a psychologist, and a social worker. The clinical team report is valid for 180 days from the earliest examination date.
For all other cases, a medical certificate is required and must be signed by a physician, psychologist, or psychiatric nurse. A medical certificate is valid for 30 days from the date of examination.
A Court must be satisfied that the incapacitated person is, in fact, incapacitated, and that the proposed person is suitable to serve as the incapacitated person’s guardian.
Where should a legal guardianship petition be filed?
A guardianship petition must be filed in the Probate Court in the Massachusetts County where the incapacitated person lives. If the incapacitated person does not live in Massachusetts, the petition should be filed in the state or country where the incapacitated person lives.
Who can be a legal guardian?
A guardian must be at least 18 years old, live in the United States, and be competent to care for the incapacitated person. A guardian need not be related to the incapacitated person. An incapacitated person may have co-guardians.
When is a legal guardianship appropriate?
Courts appoint a guardian for a person
who suffers from a clinically diagnosed condition that impairs the person’s ability to make or communicate decisions to such an extent that the individual lacks the ability to attend to their own physical health, safety, or self-care, even with appropriate technological assistance. The Court may appoint a guardian to protect the incapacitated person’s welfare.
Courts will not appoint a guardian for a person who merely shows poor judgment or difficulty making decisions. If the incapacitated person has significant assets, a Conservatorship may also be appropriate and required.
Does the court appoint a lawyer to represent the incapacitated person?
The Court has the power to appoint a lawyer to represent the incapacitated person if they or anyone on their behalf, makes such a request. If a guardian seeks authority to administer anti-psychotic drugs, or for extraordinary medical authority, the Court will appoint counsel to represent the incapacitated person. Such counsel, called Rogers counsel, will require the petitioner to file numerous additional documents.
Does a parent have a right to a court-appointed lawyer in legal guardianship case?
If your child is under 18 and involved in a guardianship case, you have the right to a lawyer. If your income is so low you cannot afford a lawyer, you have the right to a court-appointed lawyer.” Explains when and how to have a lawyer appointed.
How to apply for legal guardianship in Massachusetts?
GUARDIANSHIP OF AN ADULT IN MASSACHUSETTS
Prepared by the Mental Health Legal Advisors Committee December 2015
Guardianship generally
A guardianship is a relationship where one person (the guardian) is appointed by the court to make decisions for another person. A guardian may be appointed for a minor when the parents are deceased or incapacitated, or for an incapacitated adult.
The types of decisions a guardian can make depend on the guardianship order. If the guardianship is plenary (also called full or general), the Incapacitated Person no longer has the authority to make decisions about his or her own healthcare, support, education and welfare. A limited guardianship, however, may allow the Incapacitated Person to participate in decision making to the extent they are able. A limited guardianship can be limited to certain decisions, such as medical decisions, or decisions about where the person will live, and the incapacitated person retains decision making power in all other areas not included in the guardianship. Under Massachusetts law, all guardianship should be limited to the extent possible.1 The court and physician completing the paperwork for a guardianship must consider limits on the guardianship based on the specific strengths and deficits of the Incapacitated Person to preserve the rights of the Incapacitated Person in specific areas.2
A guardian must take into account the preferences of the incapacitated person by following the incapacitated person’s express values and desires.3 A guardian must consider the best interests of the incapacitated person when making such decisions because they are a fiduciary.4 In making the guardianship order the court shall encourage the self-reliance and independence of the incapacitated person while taking into account the person’s limitations.5
If the guardianship is ultimately granted, the guardian reports to the court annually about the incapacitated person
The authority of a guardian differs from a conservator in that a conservator makes legal decisions about a person’s property and financial matters. .
Please note that asking the court for a guardian is an important decision. There are less restrictive means that a concerned person thinking of petitioning for guardianship can use to help an incapacitated person. For more information about less restrictive options, please see MHLAC’s flier entitled “Alternatives to Guardianships and Conservatorships in Massachusetts.”
Court process
To file for guardianship or to change an existing guardianship order, there are specific forms to use, available at the Massachusetts Probate and Family Court website: http://www.mass.gov/courts/forms/pfc/upc-guardianship-of-adults-and- conservatorship.html.This link has useful information about the court process as well as links to other resources. You can ask the court clerk what paperwork you need to file or questions about court procedure.
How to obtain a guardianship
Either the incapacitated person or a person interested in the incapacitated person’s welfare can file a petition for guardianship. The petition is filed in the Probate and Family Court in the county where the incapacitated person lives.
To petition for guardianship you need to:
- file the petition for the court to appoint a guardian;
- submit a medical certificate or clinical team report with the petition. A clinical team report is used for “intellectually disabled” people.
A medical certificate is used for people with mental illness.
A medical certificate must be signed by a physician, psychologist or
psychiatric nurse. A clinical team report must be signed by a physician, psychologist and social worker.
A medical certificate is valid for 30 days from the date of examination. A clinical team report is valid for six months from the date of examination.
Therefore, in some cases the medical certificate or clinical team report will need to be updated between filing and the court hearing. This is to ensure that the medical determination is still accurate.
These are the two main documents needed in order to initiate a guardianship hearing. There are other requirements (such as notice and service of process) that you must meet before a hearing is held. When you file the paperwork, the court clerk can tell you about the other requirements.
Preparing to defend against a guardianship in court (see also Finding an Attorney, below)
Before a guardianship can be put in place over a person, there must be a court hearing. To defend against a guardianship, you can prepare for this hearing in the following ways.
Gather evidence to present at hearing that a person does not need a guardian
In general you should be sure to present evidence regarding the person’s capabilities and ability to make informed decisions. The lists below are not meant to be exhaustive and there are overlaps between the two.
For a person with an intellectual disability, gather evidence of:
- intellectual functioning;
- training programs completed in money management, basic
living skills and sex education etc;
- activities demonstrating ability to make decisions;
- employment history;
- ability to communicate through reading and writing skills;
- indications of willingness to seek guidance on decisions,
and names of people willing to give advice;
- estimate of potential for growth given more education.
For a person with mental illness, gather evidence of:
- progress in treatment programs;
- employment history;
- level of education;
- support systems in the environment where the person will
be or is living including job, school, family, friends,
outpatient treatment programs;
- if institutionalized, access to off-grounds privileges,
decreases in supervision, preparation for discharge to less restrictive environment, participation in work or training programs.
Have an expert testify at hearing that a person does not need a guardian
It is crucial to have an expert testify, such as a psychiatrist, social worker or psychologist. The expert should examine the person and form an opinion on his or her ability to manage personal and financial matters. If the person is indigent, a motion to the court may be made for an independent psychiatrist to examine him or her at the court’s expense.
Gather evidence to present at hearing about the potential guardian Gather evidence such as:
- the amount of concern and support the potential guardian provides to the respondent;
- the availability of the potential guardian;
- any possible conflicts of interest between the guardian and respondent;
- any information about hostility or abuse between the potential guardian
and respondent.
Then, to the extent that this information helps defend against the guardianship, present it at hearing.
Consider less restrictive alternatives
Consider less restrictive means other than guardianship that may be used to help a person make decisions. If a guardianship order is entered it should be the least restrictive order possible while still meeting the needs of the incapacitated person. See http://www.mhlac.org/Library.htm for further information about alternatives.
How to change a guardian
To change a guardian, there are two or three steps.
File a petition for removal OR a petition for resignation in the same court as the original order.
o A person other than the guardian would file a petition for removal. o A guardian would file a petition for resignation.
On both forms, one can include the name of a proposed new guardian. File a new petition for appointment of a guardian.
Possibly file a new medical certificate or clinical team report, depending on the circumstances.
How to end a guardianship
To end a guardianship for yourself or for another person, you must:
File a petition for termination with the same court as the original order.
An appropriate medical professional must complete a medical certificate for termination
Finding an Attorney
When defending against a guardianship
The person that the guardianship is being sought for, often called the incapacitated person or respondent, may seek legal representation by:
- requesting a court-appointed attorney using this form: http://www.mass.gov/courts/docs/forms/probate-and-family/mpc301- request-for-counsel-fill.pdf (also available at the courthouse). Fill out the form and submit it to the court where the petition for guardianship was filed. Any person can submit this form to the court to request an attorney be appointed. (If the court determines that the respondent is not indigent, the court may allow the appointed attorney to collect fees or other compensation from the respondent’s estate.)
- finding a private attorney including through the
o Massachusetts Bar Association Referral Service at (866) MASSLRS or (866) 627-7577 (toll free in Massachusetts) or http://www.massbar.org/for-the-public/need-a-lawyer; or
o county bar association referral agencies (listed online). When pursuing a guardianship
The person pursuing a guardian over someone else may seek legal representation by:
- seeking a private attorney through the Mass Bar Association Referral Service or local county bar association referral service (see above);
- contacting the Volunteers Lawyer Project (VLP) at (617) 603-1700, which represents petitioners in uncontested guardianship hearings, once one obtains a medical certificate or clinical team report.
- contacting Senior Partners for Justice (see http://www.spfj.org/gship_help.htm regarding free legal advice and help filling out the guardianship paperwork).
One may also file the petition and medical certificate or clinical team report without an attorney or find the “Attorney for the Day” at the courthouse and ask for assistance in filling out the paperwork.
Other resources on adult guardianship
Resources are available at Massachusetts Legal Services, Information on Adult Guardianships, http://www.masslegalservices.org/disabilityrightsandservices?tid=1478
Massachusetts Guardianship Association: http://www.massguardianshipassociation.org/
Rogers Guardianship
Guardians have the power to make general medical decisions for routine medical practices. However, a guardian may not consent to the administration of antipsychotic
medications or other extraordinary medical treatment without an explicit authority to do so from the court.
When a hospital or the Department of Mental Health believes that a person is incapable of giving informed consent, that entity can petition the court for a Rogers guardianship (this type of guardianship is named after a case called Rogers v. Department of Mental Health). This order gives the guardian specific authority to consent to extraordinary medical treatment on behalf of the incapacitated person.
The court must first hold a hearing. At the hearing, the court must first make a determination as to whether the alleged incapacitated person is competent to make medical decisions. If the judge finds the person to be incompetent, the judge must make a substituted judgment decision to determine what the person would choose if the person were competent.
The judge must take into account a number of specific factors in order to determine if the person would choose to take a medication(s) if that person were competent. Using the substituted judgment decision-making process to determine what the person would choose, the judge may issue a treatment order and appoint a Rogers monitor who monitors the administration of the court-ordered treatment plan.
A Rogers monitor may be the same person as the person who is the guardian, or a different person (for example, an attorney, social worker or other professional). A judge also may deny a petition for a Rogers guardianship if he or she finds that the incapacitated person would not consent to the proposed treatment if he was competent.
Obtaining a Rogers guardian
- One files a guardianship petition in the Probate Court in the county where the alleged incapacitated person lives. If the next of kin is known, one must list them on the petition. This way, the next of kin can be made aware of the matter.
- A physician must file with the court a comprehensive medical certificate.
- The court schedules a hearing date.
- If the alleged incapacitated person cannot afford an attorney the court will
appoint one. This lawyer represents the client’s wishes, not what the attorney
thinks is in the client’s best interests.
- After hearing all of the information from both sides, the judge makes a ruling
about the alleged incapacitated person’s ability to make informed decisions about antipsychotic medication or other extraordinary medical treatment. If the judge determines the person is incompetent, the judge will make a substituted judgment decision regarding the proposed treatment plan. This means that the judge determines what treatment, if any, the person would want were he or she competent, taking into account such factors as:
o the person’s expressed preferences; o religious beliefs;
o impact on family;
o side effects; and
o prognosis without treatment.
If the court approves a treatment plan, the judge will appoint a monitor,
sometimes referred to as a guardian, to make sure that the plan is being followed. This monitor cannot approve any change in the administration of antipsychotic medications. To make any changes the guardian must go back to court with a proposed modified treatment plan and get court approval.
Resources:
- Massachusetts Department of Mental Health, Rogers Guardianships, Authorizing the Use of Antipsychotic Medications — Questions and Answers, http://www.namimass.org/wp-content/uploads/brochure_rogers_guardian1.pdf
- MHLAC, Your Rights Regarding Medication in Massachusetts,http://www.mhlac.org/Docs/your_rights_regarding_medication.pdf
- Resources are available at Massachusetts Legal Services, Information on Adult Guardianships,http://www.masslegalservices.org/disabilityrightsandservices?tid=1478.
Living Arrangements
Can an Adult Foster Care member stay home alone while the caregiver is at work or school?
Whether a member can safely remain home alone depends on the member’s assessed needs, required supervision, and individual plan of care.
The caregiver must ensure that the assistance and supervision required by the care plan are available. If the member requires continuous supervision or cannot safely be left alone, appropriate care arrangements must be made. Work, school, or time away from home cannot interfere with the caregiver’s approved responsibilities.
Families should discuss the proposed schedule with their Adult Foster Care provider. Learn more about qualification and care requirements.
This information is general and educational. Caregiver approval and service requirements depend on the member’s assessed needs and individual circumstances.
Long Term Care
What you need for Apply for MassHealth coverage for seniors and people of any age who need long-term-care services
To apply, you may need to provide the following information and documents.
- Social Security numbers, if you have them, for every household member who is applying
- Proof of income and assets
- Proof of any health insurance that you are currently enrolled in or have access to
- Information about or proof of citizenship/national status or immigration status
Who can use this application?
Use this application if you live in Massachusetts and you are
- Aged 65 or older and living at home, and:
- Not the parent of a child under 19 years of age who lives with you, or
- Not an adult relative living with and taking care of a child younger than 19 years of age when neither parent is living in the home, or
- Age 65 or older and are disabled and are either working 40 or more hours a month, or are currently working and have worked at least 240 hours in the 6-months immediately before the month of the application, or
- Not working
- An individual of any age and need long-term-care services in a medical institution, such as a nursing facility or chronic hospital
- An individual who is eligible for certain programs to get long-term-care services to live at home (for more information on long-term-care services, please see the Senior Guide to Health Care Coverage)
- A member of a married couple living with your spouse, and
- Both you and your spouse are applying for health coverage
- There are no children under 19 years of age living with you
- One spouse is 65 or older and the other spouse is under 65
Learn more about eligibility for seniors and long-term care. If this does not describe you, please see Apply for MassHealth, the Health Safety Net, or the Children’s Medical Security Plan.
Private Insurance Plans: Life Insurance Vs. Long-Term Care Insurance
Long-Term Care Insurance Plans
Long-term care insurance is a type of private health insurance that provides benefits to cover some of the costs of services you might need if you develop a chronic illness or cognitive impairment.
Government Programs
In Massachusetts, the state’s Medicaid program, known as MassHealth, currently provides assistance for 65% of all nursing home residents.8 In addition, the Executive Office of Elder Affairs spends 70% of its budget on long-term care services provided in Massachusetts, but pays almost entirely for home and community-based services. To qualify for Medicaid or Elder Affairs assistance, a person may not have income or assets above a certain level.
Medicare
Many individuals incorrectly assume that Medicare will cover most of their long-term care costs. In fact, Medicare pays very little of all long-term care costs. IT IS NOT RECOMMENDED THAT YOU RELY ON MEDICARE TO PAY FOR YOUR LONG-TERM CARE NEEDS.
Medicare covers only the following long-term care services:
- Skilled Nursing Facility Benefit: After you have been in a hospital for at least three days, Medicare may pay for your care while you recover in a certified skilled nursing facility. It will only pay for up to 100 days, and you are responsible for a daily co-payment for every day in the nursing home between the 21st and the 100th day.
- Home Health Benefit: If you are confined to your home, require skilled care for an injury or an illness and meet other specific criteria, Medicare can pay in full for services provided by a Medicare certified home health care agency. Your doctor must determine that you need home health care and set up a plan of care for you. Medicare does not cover personal care services, such as assistance with dressing and bathing, unless you are homebound and are also getting skilled care such as nursing or therapy. Any covered personal care must also relate to the treatment of an illness or injury and you can only get a limited amount of personal care in any week. Additionally, if you purchase a private Medicare Supplement plan (also called a Medigap plan) or enroll in a Medicare HMO plan, these plans will usually not pay for long-term care services that are not covered by Medicare. In Massachusetts, Medicare supplement policies do not cover long-term care costs, but Medicare Supplement 1 and Medicare Supplement 2 policies do pay for the copayments for days 21 through 100 for Medicare-approved stays in nursing homes.
Veterans Benefits
If you are a veteran, you may be eligible for some long-term care services in a Veterans Administration (VA) facility. To find out whether you would be eligible for assistance, contact your city/town government’s Veterans Agent or the Massachusetts Department of Veterans’ Services.
The Home Care Program
This program, associated with the Executive Office of Elder Affairs, provides services to help frail elders live independently in their own home for as long as possible. Services available for income eligible individuals include case management, home health aides, homemakers, home delivered meals, transportation, respite care and adult day care services. These services are provided through Aging Services Access Points (ASAPs) and regional Area Agencies on Aging.
Medicaid
The Massachusetts Medicaid program, known as MassHealth. MassHealth does pay for nursing home care and some home and community-based services for certain income-eligible people living in Massachusetts. To be eligible for MassHealth and receive long-term care services, you must meet state and federal eligibility rules.
Life Insurance Plans
Certain life insurance policies can be used to help finance your long-term care while you are still alive. As with other means of financing, you should check with your financial planner, either an estate lawyer or a qualified advisor, to determine the best course of action for someone in your specific circumstance. Please visit the Division’s webpage on Life Insurance for more information about options.
How Could You Plan to Pay for Long-Term Care?
Your personal circumstances should play a large role in determining how you will cover the costs of long-term care. You should consult professional advisors (such as an estate-planning lawyer or other qualified person) to consider your specific situation, including the impact of any option on your spouse or dependents, before making any decisions about how to finance your long-term care.
Savings, Pensions and Other Retirement Accounts
Many people save all their lives to have funds for retirement. These resources are intended not only to afford a comfortable standard of living in retirement, but also to prepare for certain predictable expenses, e.g., a new roof or a new car. These resources could also be considered to pay for longterm care costs. You should consider all of your liquid assets, such as savings accounts, CDs (certificates of deposit), money market accounts, stocks, bonds, mutual funds, annuities, pension plans, profit sharing or employee stock option retirement plans and Individual Retirement Accounts (IRAs). You could use any of these sources to pay for long-term care services when they may be needed.
Residential and Real Property
In addition to your liquid assets, you may own other property that can contribute to paying for the costs of care. These assets could include your home, motor vehicle or other property. Although the value of these assets should be considered in making decisions, neither the Division of Insurance nor any other state agency recommend that any specific asset be sold. Homeowners may also be able to tap into the value of their homes without selling them. Some financial organizations offer reverse mortgages or special loans that enable you to continue living in your own home. Some of these contracts will guarantee payments in return for a new mortgage on your home. If you wish to investigate this option, you should contact organizations such as Homeowners Options for Massachusetts Elders.
Who Pays the Costs of Long-Term Care?
At present, most long-term care is paid for from:
- an individual’s own resources,
- his or her family’s resources or
- Medicaid, the federal-state government program designed to cover the health care costs of a mostly indigent population.
Contrary to popular belief, traditional health insurance and Medicare usually provide little or no coverage for long-term care. Currently, most people who need long-term care services must pay for it on their own unless:
- (a) they have long-term care insurance policies with benefits for the services they need or
- (b) they are or become eligible for Medicaid or other government assistance.
What Types Of Long-Term Care Services Are Available in Massachusetts and How Can You Access Them?
There are a variety of long-term care services in the Commonwealth that are regulated or monitored by a state agency. Listed below are brief descriptions of each of the services and what organizations to contact for more information. It is important to remember that each service has different financial, medical and functional eligibility requirements.
Services in the Home
Chore Services
- Non-medical services provided in an individual’s home to help continue independent living, including: vacuuming, washing floors and walls, defrosting freezers, cleaning ovens, cleaning attics and basements to remove fire and health hazards, changing storm windows, performing heavy yard work, shoveling snow and making minor home repairs.
- Contact your local Aging Services Access Points (ASAP) through the Executive Office of Elder Affairs.
Home Care
- Non-medical services designed to maintain an individual’s ability to live independently including shopping, planning menus, preparing meals, home delivered meals, laundry, and light house cleaning and maintenance, including vacuuming, dusting, dry mopping, dishwashing, cleaning the kitchen/bathroom and changing beds.
- Contact your local ASAP through the Executive Office of Elder Affairs.
Personal Care
- Non-medical services to help with activities of daily living, including assistance with bathing, bedpan routines, foot care, dressing, and care of dentures; shaving and grooming; assistance with eating; and assistance with moving around the home and getting in and out of bed and/or a wheelchair.
- Contact your local ASAP through the Executive Office of Elder Affairs.
Home Health Care
- Skilled medical and other services, including nursing, occupational therapy, physical therapy, speech therapy and home health aide services, are supplied by certified home health agencies and other professionals to help individuals remain at home.
- Contact your local ASAP through the Executive Office of Elder Affairs or contact the Home Health Care Association of Massachusetts
Specialized Home or Facility Services
Respite Care
- Medical and non-medical services to temporarily relieve caregivers of the daily stresses and demands of care for a family member. Respite could be for a few hours or a few days, depending on the needs of the caregiver and the resources available. In addition to home care, personal care and home health care, respite care services may include short-term placements in adult foster care, assisted living facilities and nursing facilities or rest homes.
- Contact your local ASAP through the Executive Office of Elder Affairs.
Hospice Care
- Medical services with an emphasis on providing comfort and pain relief for those who are terminally ill.
- Contact Medicare or the Hospice Federation of Massachusetts.
Services in a Community Setting
Social Day Care
- Non-medical services designed to encourage physical and mental exercise and stimulate social interaction. Services are suited to the needs of participants with training, counseling and social services in a community setting, including assistance with walking, grooming eating and planned educational, recreational and social activities.
- Contact your local ASAP through the Executive Office of Elder Affairs.
Adult Foster Care
- Mostly non-medical services providing room, board, and personal care in a family-like setting to individuals who cannot live alone safely. Services include companionship, assistance with activities of daily living, host family training and monthly nurse and social worker visits to monitor placements.
- Contact your local ASAP through the Executive Office of Elder Affairs.
Adult Day Health
- Medical and other services allowing frail elders to remain in the community while coping with medical conditions, chronic debilitating illnesses or diseases that require careful monitoring and intervention. Services include therapeutic, nutritional, social and rehabilitative services, as well as support and education for participants, families and caregivers.
- Contact your local ASAP through the Executive Office of Elder Affairs or contact the Division of Medical Assistance.
Dementia Day Care
- Non-medical services in a structured, secure adult day program for individuals with dementia (Alzheimer’s Disease or a related disorder) to maximize their functional capacity, reduce agitation, disruptive behavior and the need for psychoactive medication, and enhance cognitive functioning. This allows a person with dementia to stay in the community, provides the caregiver with respite from caregiving responsibilities and includes support and education for participants, families and caregivers.
- Contact your local ASAP through the Executive Office of Elder Affairs.
Services in a Facility Assisted Living
- Independent housing that provides room, board and personal care, as well as a range of services, including social and educational programming and case management. Individuals can transition from completely independent housing units to extensive personal care within the same facility. Some assisted living facilities have designated units for persons with Alzheimer’s Disease.
- Contact the Executive Office of Elder Affairs, the Massachusetts Assisted Living Facilities Association or the Massachusetts Extended Care Federation.
Continuing Care Retirement Communities (CCRCs)
- Housing, personal care and health care in one location. Although arrangements vary widely, individuals usually pay privately through an initial investment and then monthly service fees for a variety of services ranging from assisted living to nursing home care.
- Contact the Executive Office of Elder Affairs or the Massachusetts Extended Care Federation.
Nursing Homes
- A facility licensed by the Department of Public Health that is primarily engaged in providing nursing care and related services on an inpatient basis for short and long-term care stays at skilled, intermediate or custodial levels of care.
- Contact the Department of Public Health, the Executive Office of Elder Affairs or the Massachusetts Extended Care Federation.
Will You Need Long-Term Care? For How Long?
It is impossible to predict your individual chances of needing long-term care. For some, the need may follow a major illness, while for others the need may evolve more gradually. Some may require many years of long-term care, while others might need services for only a matter of months.
The following chart outlines the probability of an individual being admitted to a nursing home at age 65.
| Nursing Home Stay of: |
Chances for Men |
Chances for Women |
| 0 – 3 months |
11% |
11% |
| 3–12 months |
8% |
10% |
| 1– 5 years |
10% |
18% |
| More than 5 years |
4% |
13% |
| Of any duration |
33% |
52% |
Please note that these figures do not include people who require home or community-based long-term care services. There are a large number of different services that are available to you in your home which can allow you to “age in place” and never have to move into a nursing home. The above statistics also do not reflect the fact that as lifestyle and medical advancements allow people to live longer, more people will need long-term care. Therefore, your actual probability of needing at least some type of long-term care during your life is probably higher than these numbers suggest.
How Much Could Long-Term Care Cost?
Nursing home care is the most expensive and intensive form of care. In 2014, a private pay patient’s charge for a stay in a Massachusetts nursing home was approximately $361.77 per day. Although the most recent study estimated that the average length of stay in a nursing home was 272 days, some stays last for many years. At $361.77 per day, the average annual cost of a nursing home stay exceeds $132,000, but it is not unusual for an individual to pay more than $150,000 per year in some nursing homes.
Assisted living is another form of facility-based long-term care. If you lived in a single occupancy assisted living studio apartment, the cost of assisted living, including the cost of rent, food, electricity and heat, and many services such as personal care, housekeeping, meals and laundry, would range from approximately $2,000 per month to more than $7,000 per month, or from $24,000 to $84,000 per year.
There is, however, great variation in services provided in assisted living facilities and prices could vary. The cost of long-term care services provided outside of a nursing home varies depending on the type of service, as well as the intensity and duration of the service.
The cost of long-term care services provided outside of a nursing home varies depending on the type of service, as well as the intensity and duration of the service. In 2014, if you receive 2 hours of skilled care from a nurse in your home three times per week for a year it could cost $31,200, or an average of $200 per day of care. If you receive 2 hours of personal care from a certified home health aide in your home three times per week throughout the year, the annual cost could be approximately $9,360, or an average of $60 per day of care. If you receive 2 hours of personal care from a personal care aide/homemaker in your home three times per week throughout the year it could cost $7,800, or an average of $50 per day of care.
All the presented figures are subject to inflation. You should note that if long-term care costs were to increase by 5% annually, the overall cost would double in approximately 15 years.
What is Long Term Care?
When you think about “long-term care”, you may think about care in a nursing home. But long- term care includes an ever-changing array of services aimed at helping people compensate for limitations in their ability to live independently. Long-term care should meet your medical needs, as well as your social, financial and housing needs. It can range from assistance with household chores to assistance with activities of daily living to highly skilled medical care.
Long-term care services may be provided in a variety of settings such as the home, community sites (adult day care centers) or nursing homes. The type and setting of long-term care services depend upon your particular needs. Those with physical illnesses or disabilities often need hands-on help with basic activities of daily living (“ADLs”) including bathing, eating, dressing, toileting, continence and transferring. Those who are cognitively impaired usually require supervision or verbal reminders to perform routine activities or to stay out of harm’s way. Skilled care is provided on a doctor’s order by medical personnel such as registered nurses or professional therapists. Although it can be provided in a nursing home, skilled care may be provided in the home by visiting nurses or therapists. Personal care (also known as “custodial care”) is provided to help people perform ADLs but is less intensive than skilled care and does not require the services of a medical professional. Personal care may be provided in many settings, including a person’s home or adult day care center.
What Types of Home Health Care Services Are Available in Massachusetts?
Home health care may include several types of medically necessary services delivered in a person’s home, depending on their needs, insurance coverage, and authorization requirements.
Common home health services may include:
- Skilled nursing, such as wound care, medication administration, health monitoring, and other nursing services
- Physical therapy to improve mobility, strength, and physical function
- Occupational therapy to help individuals perform daily activities more safely and independently
- Speech-language therapy for communication or swallowing needs
- Medical social services to help coordinate care and connect individuals with appropriate resources
- Home health aide services when authorized as part of an eligible home health plan of care
Other supports, such as transportation, meal delivery, companionship, homemaker services, or pharmacy delivery, may also be available in the community, but they are not the same as skilled home health care.
Adult Foster Care is also different from home health care. Adult Foster Care provides eligible MassHealth members with daily personal care from a qualified live-in caregiver, together with nursing oversight and care management.
Compare different types of home care services in Massachusetts and learn how to choose a home care provider.
Managed Care Option (MCO)
Is enrollment in a MassHealth managed care plan mandatory?
Whether enrollment in a MassHealth managed care plan is required depends on the member’s eligibility category, age, other insurance, and program participation.
Many managed-care-eligible MassHealth members are required to choose a health plan, such as an Accountable Care Organization (ACO), Managed Care Organization (MCO), or Primary Care Clinician (PCC) Plan. If a member does not make a selection, MassHealth may assign a plan.
Other members, including many individuals age 65 or older and certain long-term-care populations, may receive MassHealth on a fee-for-service basis and are not required to enroll in an MCO.
Because the rules vary by member, families should review the specific MassHealth enrollment options available to them before changing plans.
What is a managed care option (MCO)?
A Managed Care Organization (MCO) is a health plan that contracts with MassHealth to provide and coordinate covered health care services for enrolled members through a network of doctors, specialists, hospitals, behavioral health providers, and other participating providers.
Members enrolled in an MCO generally receive most covered services through the plan’s provider network and must follow the plan’s rules for referrals, prior authorization, and other care-management requirements when applicable.
MassHealth offers different managed-care arrangements, and the options available to a member depend on factors such as eligibility category, age, location, and other coverage.
MassHealth
What Is MassHealth Adult Foster Care?
MassHealth Adult Foster Care is a home-based program for eligible MassHealth members who need daily physical assistance or cueing and supervision with at least one qualifying activity of daily living.
The member lives with a qualified caregiver who provides personal care and support. The program also includes professional nursing oversight, care management, caregiver training, and an individualized plan of care.
Coverage alone does not guarantee approval. Read our complete Massachusetts Adult Foster Care guide.
Official sources: MassHealth program fact sheet and 130 CMR 408.000.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
You can also learn who may need caregiver services.
What Types of Home Health Care Services Are Available in Massachusetts?
Home health care may include several types of medically necessary services delivered in a person’s home, depending on their needs, insurance coverage, and authorization requirements.
Common home health services may include:
- Skilled nursing, such as wound care, medication administration, health monitoring, and other nursing services
- Physical therapy to improve mobility, strength, and physical function
- Occupational therapy to help individuals perform daily activities more safely and independently
- Speech-language therapy for communication or swallowing needs
- Medical social services to help coordinate care and connect individuals with appropriate resources
- Home health aide services when authorized as part of an eligible home health plan of care
Other supports, such as transportation, meal delivery, companionship, homemaker services, or pharmacy delivery, may also be available in the community, but they are not the same as skilled home health care.
Adult Foster Care is also different from home health care. Adult Foster Care provides eligible MassHealth members with daily personal care from a qualified live-in caregiver, together with nursing oversight and care management.
Compare different types of home care services in Massachusetts and learn how to choose a home care provider.
Is enrollment in a MassHealth managed care plan mandatory?
Whether enrollment in a MassHealth managed care plan is required depends on the member’s eligibility category, age, other insurance, and program participation.
Many managed-care-eligible MassHealth members are required to choose a health plan, such as an Accountable Care Organization (ACO), Managed Care Organization (MCO), or Primary Care Clinician (PCC) Plan. If a member does not make a selection, MassHealth may assign a plan.
Other members, including many individuals age 65 or older and certain long-term-care populations, may receive MassHealth on a fee-for-service basis and are not required to enroll in an MCO.
Because the rules vary by member, families should review the specific MassHealth enrollment options available to them before changing plans.
What is a managed care option (MCO)?
A Managed Care Organization (MCO) is a health plan that contracts with MassHealth to provide and coordinate covered health care services for enrolled members through a network of doctors, specialists, hospitals, behavioral health providers, and other participating providers.
Members enrolled in an MCO generally receive most covered services through the plan’s provider network and must follow the plan’s rules for referrals, prior authorization, and other care-management requirements when applicable.
MassHealth offers different managed-care arrangements, and the options available to a member depend on factors such as eligibility category, age, location, and other coverage.
Does MassHealth pay for home care?
Yes. MassHealth covers several home- and community-based services for eligible members, depending on the person’s coverage, clinical needs, and program requirements.
One option is Adult Foster Care, which allows an eligible MassHealth member to receive daily personal care from a qualified live-in caregiver, together with nursing oversight and care management. The caregiver may be a family member, except for certain excluded relationships such as a spouse or legal guardian.
MassHealth also covers certain home health services, such as skilled nursing, medication administration, therapy, and home health aide services when applicable medical-necessity and authorization requirements are met.
Because the right program depends on the individual’s needs and coverage, families should review their specific situation before assuming one type of home-care service applies. Learn more about Adult Foster Care in Massachusetts.
What MassHealth coverage is required for Adult Foster Care in Massachusetts?
The member generally needs qualifying MassHealth coverage, such as MassHealth Standard or CommonHealth. Coverage should be verified for the individual applicant because benefit and enrollment circumstances can differ.
Qualifying coverage does not automatically establish Adult Foster Care eligibility. The member must also meet the clinical and living-arrangement requirements, and the caregiver and qualified setting must be approved.
Read our qualification guide, or call MassHealth at 800-841-2900 with questions about coverage.
Official sources: MassHealth program fact sheet and 130 CMR 408.000.
This information is general and educational. Eligibility and authorization depend on current requirements and individual circumstances.
OneCare
HOW DO I SIGN UP FOR ONE CARE?
If you are eligible for One Care, MassHealth will send you a letter and a packet of information in the mail. The packet will list the One Care plans available in your city or town. You can choose any One Care plan available in the city or town where you live. The packet will explain how to choose a plan, and you must fill out a form and mail it in to MassHealth to choose a plan. If you do not tell MassHealth which plan you want, MassHealth will automatically enroll you in one.
For the first 90 days after you enroll in a One Care plan, you can continue to receive the same care you have been receiving, and One Care will pay for that care. After 90 days, you will be able to access the care listed in your Personal Care Plan through providers that accept One Care.
WHAT DOES ONE CARE COVER?
One Care covers all the services that are ordinarily covered by MassHealth and Medicare. One Care does not offer you any additional benefits. Some One Care plans also cover community-based behavioral health services. Instead of receiving coverage from both Medicare and MassHealth, however, all of your care will be covered by a single One Care plan. But, please keep in mind that many of your current services may be interrupted or cancelled when you sign up for One Care.
WHAT HAPPENS IF I AM ELIGIBLE FOR ONE CARE, BUT I DON’T WANT TO ENROLL?
If you are eligible, it is your choice whether you receive your care through One Care or not. However, if you do not want to enroll in OneCare, you must tell MassHealth by calling 800-841-200. Otherwise, you will be automatically enrolled in One Care. If you choose not to enroll in One Care, you will continue receiving health care coverage from Medicare and MassHealth the same way you do now.
Personal Care Attendant (PCA)
What do I need to do to get a job as a PCA?
Visit the PCA Workforce Council’s new PCA referral directory at www.MassPCAdirectory.org to register and complete an application for employment
Are there any restrictions on who can be hired as a PCA?
A person cannot be hired if he/she is the PCA Consumer-employer’s spouse, parent/foster parent (if PCA Consumer-employer is a minor), or surrogate (legally responsible decision maker).
What are the benefits for PCAs?
- $15.75/hour (effective July 1, 2020)
- Earned sick leave
- Unemployment insurance
- Workers compensation
- Free training opportunities through Home Care Training Benefit (1199 SEIU):
- CPR/First Aid
- Blood borne pathogens
- Communication skills
- Topics in computers
- Transfers and Mobility
- Alzheimer’s and Dementia
- Medication safety
- PCAs are eligible for college tuition vouchers after completing a year of, at least, part-time employment
- PCAs are eligible to complete the Certified Nurse Aide program after completing a year of, at least part-time, employment
What should be considered to become a PCA in Massachusetts?
- It is at each PCA Consumer-employer’s discretion to run a CORI, SORI or drug test
- Working full time (up to 50 hours/week) or part-time (as few as one hour per week)
- Each PCA Consumer-employer has their own preferences for worker certification, licensure or educational attainment
What is required to be a PCA in Massachusetts?
- Legally able to work in United States
- Understand and carry out instructions of the PCA Consumer-employer
- At least age 14.5 years old with working papers
Who is the employer?
PCA Consumer-employers are responsible to hire, train, manage, and, if needed, terminate the PCA. The PCA Consumer-employer is listed as the employer on the I-9 and W-4. PCAs are not independent contractors, taxes are withheld.
What is a Personal Care Attendant (PCA)?
A PCA is a person recruited and hired by an individual (PCA Consumer-employer) to physically assist in performing tasks, such as:
- bathing and dressing
- denture care
- help with toileting
- meal preparation and feeding
- housekeeping and shopping
- help with ambulation and transfers
What is the Personal Care Attendant (PCA) Program?
The Personal Care Attendant (PCA) program is delivered by MassHealth to provide funds for people with disabilities (PCA Consumer-employer) to hire Personal Care Attendants to assist with activities of daily living.
What is a PCA surrogate?
The surrogate is often a family member but may be any other person you choose who has the ability to manage the program. A surrogate can assist you with managing any part of the PCA program with which you have difficulty, but a surrogate does not necessarily run your PCA program for you.
Who Can Be a PCA for a Family Member in Massachusetts?
Family members may be able to work as a Personal Care Attendant (PCA) for an eligible MassHealth member in Massachusetts, subject to PCA program requirements.
The PCA program is consumer-directed, meaning the MassHealth member receiving services, or their designated representative when applicable, is responsible for directing the PCA’s work.
Eligible PCAs may include certain adult family members, such as adult children, siblings, grandchildren, nieces, nephews, or other qualified individuals.
The rules for who may serve as a PCA are different from the rules for Adult Foster Care, so families should review the requirements of the specific program they are considering.
PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
WHAT HAPPENS AFTER I’M ENROLLED?
Once you join a PACE Elder Service Plan, you must receive all your health services from within your organization. You’ll get your medications, including your Medicare Part D-covered drugs, through the PACE program and will not need to join a separate Medicare Prescription Drug Plan. If you do join a separate Medicare Prescription Plan, you will be disenrolled from your PACE health and prescription drug benefits.
HOW DO I APPLY?
After you decide which PACE Elder Service Plan is right for you, contact the plan directly at the phone number provided above to apply and a staff member will help you enroll.
WHAT PACE ELDER SERVICE PLAN SITES ARE AVAILABLE?
There are six PACE Elder Service Plan sites in Massachusetts.
- Elder Service Plan of the Cambridge Health Alliance
- Elder Service Plan of the East Boston Neighborhood Health Center
- Elder Service Plan of Harbor Health Services
- Summit ElderCare of the Fallon Community Health Plan
- Elder Service Plan of the North Shore
- Upham’s Elder Service Plan
Each Elder Service Plan has a specific service area and may offer different benefits and services. The table below summarizes the service areas for the six Elder Service Plan sites. To enroll in a plan, you must live in that plan’s service area.
If you are eligible for more than one plan, you should compare the benefits and services offered by each plan and find the one that is the best fit for you. To learn more about each Elder Service Plan, you can call the Plan directly or visit its website.
WHAT SERVICES ARE COVERED BY PACE?
- The PACE Elder Service Plans are like one-stop shops that cover preventive, primary, acute, and long-term care services. The coordinated care that PACE covers includes:
- Primary and specialty medical care
- Emergency care
- Medical supplies and equipment
- Prescription drugs
- Physical, occupational, and recreational therapy
- Dental, podiatry, vision, and audiology services
- Nutritional counseling and meals
- Adult day health care
- Transportation to the health center
- Nursing facility care if needed
- Hospitalization
- In-home services
- Family caregiver support
The services are available 24 hours a day, 7 days a week, every day of the year. There are no copayments, deductibles, or other cost-sharing fees. However, you may have to pay a monthly premium.
CAN I GET PACE?
To be eligible for PACE you must meet the following criteria:
- Are age 55 or older
- Live in the service area of a PACE Elder Service Plan organization (see
below)
- Are able to live safely in the community
- Are certified by the state as eligible for nursing home care
o This usually means that you need assistance with some activities of daily life, like getting dressed or preparing your meals, and that you also have a skilled need, such as physical therapy. A medical professional will evaluate you based on your health status to determine if the PACE program is right for you.
o Though you must be certified to need nursing home care, the large majority of PACE enrollees do not actually reside in nursing homes, but instead receive their care within their own communities.
• Agree to receive health services exclusively through the Elder Service Plan/PACE organization
If you have MassHealth, you must also meet the following income and asset criteria:
- Your countable income must be less than $2130 per month in 2013
- Your countable assets must be no greater than $2000
Your spouse’s income and assets are not counted. If you have MassHealth and you meet the criteria above, there are no fees for the program.
If you do not have MassHealth but you do have Medicare, you may have to pay a monthly premium. However, you will not have to pay any copayments, deductibles, or other cost-sharing fees.
If you don’t have Medicare or MassHealth, you may be able to pay for PACE privately.
PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
The Elder Service Plans within the Programs of All-Inclusive Care for the Elderly (PACE) provide medical and social services for frail elders 55 years and older. MassHealth and Medicare cover the services that are provided by a team of health professionals so that elders can stay in their homes and communities instead of having to go to a nursing home. This program is meant to provide quality, individualized, and streamlined care for elders in a more cost-effective manner than the typical fee-for-service structure provides.
Senior Care Options (SCO)
WHAT SENIOR CARE OPTIONS PROGRAMS ARE AVAILABLE?
- In 2013, there are five programs available in Massachusetts:
Once you’ve figured out which programs you are eligible for, you can compare the benefits and services offered by each program by visiting its website or calling the program directly. It is important to remember that SCO will only cover care that you receive from providers within the SCO’s network. For example, if you already have a doctor you like, but he or she is not affiliated with the SCO you plan to enroll in, that SCO may not be the best choice for you.
WHAT SERVICES ARE COVERED BY SCO?
SCO covers the following health care services:
- All the health care services covered by MassHealth Standard
- If you have Medicare, all the health care services covered by Medicare
- Coordination of your health care
- Specialized geriatric support services
- Adult day care
- Comprehensive dental care
- 24-hour access to medical support
- Home care services
- Family caregiver support
SCO plans combine your Medicare benefits (if you have Medicare), MassHealth benefits, prescription drug plan benefits, and extra SCO services into one plan with one health insurance card. However, the SCO program only covers services provided by your SCO and its network of providers. It will not cover services from other doctors or health care providers, except in an emergency.
The benefit of SCO is in the coordination of care—your primary care physician will work with you and your team of nurses, specialists, and a geriatric support services coordinator to develop a plan of care that specifically addresses your needs.
AM I ELIGIBLE FOR SCO?
To be eligible for SCO you must meet the following criteria:
- Age 65 or older
- Eligible for MassHealth Standard
- Live in the service area of a SCO (see below)
- Do not have end stage renal disease
- Agree to receive covered health services exclusively through their SCO
options plan
SCO is open to seniors in all living situations, including people living by themselves, at home with support services, and in long-term care facilities.
You do not have to have Medicare to be eligible for SCO. If you have MassHealth Standard but do not have Medicare, you can choose a SCO plan. If you do have both MassHealth and Medicare, you can choose a Medicare Advantage Senior Care Options HMO SNP (Special Needs Plan).
Senior Care Options (SCO)
Senior Care Options (SCO) is a Medicare-MassHealth partnership that provides services for low-income seniors over the age of 65. The purpose of SCO is to help seniors stay healthy and out of nursing homes by using a coordinated team of health professionals that cares for the seniors at their homes or in long-term care facilities.
SOCIAL SECURITY DISABILITY INSURANCE
WHERE CAN I GET MORE INFORMATION ABOUT SSDI?
For more information you can access SSA’s electronic booklet on SSDI at http://www.ssa.gov/pubs/10029.html. The SSA’s official website contains several helpful resources, including a Benefit Calculator and a Social Security Office Locator. You can also e-mail general questions to Social Security through their online portal, or call Social Security directly. For contact information, please refer to the General Resources section below.
CAN I KEEP WORKING ONCE I’M RECEIVING SSDI BENEFITS?
If you would like to keep working, you can do so as long as your income is not too high. Once your income reaches the maximum amount and SSA determines you are able to engage in “substantial gainful activity,” you will lose your SSDI benefits.
When you first start working, you get a trial work period during which you get full SSDI benefits regardless of your income. Your trial work period ends after 9 months. You then get 36 more months, during which you can work and still get SSDI benefits. During these 36 months, called the extended period of eligibility, you get SSDI benefits as long as your earnings that month are less than “substantial.” In 2013, SSA determined that any income above $1040 was “substantial.” Once you earn more than a substantial income in any month, you get a grace period of three months and then you will lose your SSDI benefits.
If you lose your SSDI benefits because you have substantial income, you have five years to ask for your SSDI benefits back if your disability again prevents you from working. During those five years, you do not have to reapply for SSDI or wait for a disability reevaluation and your benefits will be reinstated in an expedited manner.
It is important to note that you should be honest and straightforward about your employment, even if you are being paid “under the table.” If you cannot prove how much you are making, it is often assumed that you are making over the limit and your benefits may be lost. Not documenting how much income you earn may also undercut your credibility, and your credibility may be one of the most important factors in the outcome of an appeal.
WHAT HAPPENS AFTER I’M ENROLLED?
You will get SSDI benefits as long as you are disabled under the eligibility criteria above and cannot engage in substantial gainful activity. When you reach retirement age, your benefits are converted to Social Security retirement benefits.
Your case may be reviewed by Social Security any time within 6 months or no sooner than 7 years, depending on whether your specific condition is expected to improve or not. The award letter you receive from Social Security after you first apply will tell you when your first review will take place. The review will involve a request for updated medical information to prove that you are still eligible for SSDI benefits. You will not have to fill out the SSDI application again.
WHAT HAPPENS AFTER I APPLY?
Once you apply, it usually takes about 3-5 months before your benefits start. Your SSDI payments begin on the sixth month after your disability begins. You can check on the status of your SSDI application on the Social Security website at https://secure.ssa.gov/apps6z/IAPS/applicationStatus or you can call Social Security toll-free at 1-800-772-1213 (TTY: 1-800-325-0778).
If you are denied and do not agree with the decision, you can appeal to Social Security. You must appeal in writing within 60 days of receiving your denial. Instructions on how to appeal will be sent with the denial. This next step, known as a reconsideration, involves more paperwork and typically takes 3-4 months. If you are again denied, you can file for a hearing and may also consider seeking the help of an attorney. This process varies widely, but typically takes around 6-8 months.
HOW DO I APPLY?
You can apply online at the SSA’s website at http://www.socialsecurity.gov/applyfordisability/. When applying online, only you can apply for yourself. No one else can apply for you.
You can also apply by phone. You need to first call the Social Security’s toll-free number at 1-800-772-1213 (TTY: 1-800-325-0778) Monday through Friday between 7 AM and 7 PM to schedule an appointment to apply over the telephone.
Lastly, you can also apply in person. Find the Social Security Office nearest you using the Office Locator at https://secure.ssa.gov/apps6z/FOLO/fo001.jsp and call to set up an appointment.
Before you apply, be prepared with the following documentation:
- Social Security number
- Birth certificate or other proof of age 50
- Proof of U.S. citizenship or lawful alien status if you were not born in the U.S.
- Most recent W-2 form, or federal tax return if self-employed
- Military discharge papers if you had military service
- Summary of where you worked and the kind of work you did for the last 15
years
- Names and dosages of all the medicines you take
- Names, address, and phone numbers of hospitals, clinics, doctors, and
other health workers who treated you and dates of treatment
- Medical records that you have in your possession
- Laboratory and test results
- Name of your bank and account number, if you want benefits deposited
directly into your bank account
If you are applying for family members, you should also have their birth certificates and Social Security numbers, proof of U.S. citizenship or lawful alien status, and, for your spouse, a marriage certificate.
The most helpful proof of your disability is medical records, particularly any records related to treatment you received for your disability. Even if you don’t like or don’t want to see doctors, it is always important to get the most treatment that you can. Even if your condition is genuine, you will not be able to get very far in the application process without documentation and treatment. It is also helpful to have evidence from former employers that state that you tried to do your job but were unable to because of your disability.
If you have difficulties with substance abuse, you should try to get clean and look for treatment to increase your chances of obtaining SSDI benefits. If it is found that your substance abuse is the reason that you are disabled and can’t work, you will be denied SSDI benefits. If you have a history of substance abuse, the best way to get benefits is to be clean for a certain period of time.
For all the documents, you must provide originals or certified copies. You can mail or bring these documents to the Social Security office. Though the office will make copies and return the originals, it is always a good idea to make copies yourself of important documents before handing over the originals.
If you are unable to find any of the necessary documents, begin the application process anyway and work with Social Security to get the rest of the documents that you need. Don’t delay applying because you don’t have all of your documents.
If you need help applying in other languages, you can go online to Social Security’s Multilanguage Gateway athttp://www.ssa.gov/multilanguage/index.htm to see the publications that are available. You can also call Social Security’s toll-free number at 1-800-772-1213 and press “2” for Spanish and “1” for all other languages to be connected to an interpreter. Social Security can also arrange to have an interpreter come to your local office for your appointment.
WHAT SERVICES ARE COVERED BY SSDI?
If you enroll in SSDI, you will receive a monthly Social Security payment as long as you are disabled and cannot work. The amount you receive will depend on your age, the number of years you worked before becoming disabled, and the amount you earned in Social Security covered employment. If you would like to get an estimate of your SSDI benefit amount, you can view your Social Security statement online at the SSA website athttp://www.ssa.gov/planners/benefitcalculators.htm. For more information, you can call the SSA toll-free at 1-800-772-1213.
You might also be eligible for retroactive SSDI benefits up to 12 months if your disability began more than six months before you applied for SSDI. At 24 months of receiving SSDI benefits, you are automatically entitled to coverage under Medicare Parts A and B. Your eligible spouse or child may get a monthly benefit up to half of your monthly benefit. That amount will vary based on your work history.
CAN I GET SSDI?
To be eligible for SSDI, you must:
- Be under 65 years of age
- Have a lawful immigration status
o You do not have to be a citizen, but you must legally be in the United States and have a valid Social Security number. You must have proof of your legal status.
o If you had been working using a false Social Security number, you should contact a legal services organization for help with claiming your past employment. A list of legal services programs that provide free or low cost legal help can be found at http://www.massresources.org/legal-services.html.
- Meet the Social Security five month waiting period (you will start getting benefits for the sixth full month after your disability began)
- File an application for SSDI benefits (see below)
- Be totally disabled according to the Social Security definition of disability
o This means that your disability prevents you from engaging in “substantial gainful activity” for at least 1 year or will result in death. Your disability must either be in the list of SSA’s disabling conditions or must stop you from doing any type of work. It is not enough to show that you are unable to do what did for your previous job. You need to also show that you are not able to do any work on a full time basis.
For example, if your previous job involved heavy lifting but you injured your back, you might still be able to work a full-time position at a desk job. You would not be eligible for SSDI in that situation.
o You can be working part-time, but you must be earning less than $1040 a month.
o SSDI does not give benefits if you are partially disabled or if your disability is short-term. Your disability does not have to be permanent, but must be expected to last at least 12 months or result in death. Once you are no longer considered disabled, your SSDI benefits will stop.
• Have sufficient work history and contribution to the Social Security program. You can access a copy of your Social Security statement online from the SSA at http://www.socialsecurity.gov/mystatement/. You will have to first create a free account and then access your statement with your username and password. If you do not have enough credits, you cannot get SSDI benefits, but you may qualify for Supplemental Security Income, a need-based cash assistance program, if you are disabled. You can go to http://www.massresources.org/ssi to learn more about Supplemental Security Income.
o The table below summarizes what qualifies as sufficient contribution for SSDI for each age group. The age group is determined by the age at which the disability first occurs
There is no asset limit for SSDI.
If you qualify for SSDI benefits, your family members will also be eligible for SSDI benefits if they fall into one of the following categories:
WHAT IS SOCIAL SECURITY DISABILITY INSURANCE?
Social Security Disability Insurance (SSDI or SSD) is a federal disability insurance program, administered by the Social Security Administration (SSA), for disabled individuals who have paid into the Social Security program. Eligible individuals receive monthly benefits ranging from several hundred to several thousands of dollars because of a combination of work history and a current inability to work.
Supplemental Nutrition Assistance Program (SNAP)
I have seen people purchase non-food items with an EBT card. I thought SNAP was only for food?
Yes. SNAP benefits are only for food. However, some people also use their DTA EBT card for EAEDC or have an EBT card for their TAFDC (cash assistance) benefits. You can use TAFDC or EAEDC benefits to purchase food and non-food items.
For information or to apply for on TAFDC or EAEDC eligibility, call your local DTA office or go to contact your local DTA office. You can check your eligibility and apply for TAFDC or EAEDC at www.DTAconnect.com
Does receiving SNAP affect my taxes?
No. SNAP benefits are not considered income.
I received an EBT card but balance is $0. What does this mean?
When you apply for SNAP and don’t already have an EBT card, DTA should send you an EBT card by mail. The card may arrive before your application is processed and therefore have a $0 balance. Benefits will be added to the card once your application is fully processed, which an take up to 30 days.
How long will it be until I get my SNAP benefits?
If you are approved for SNAP: you will receive your benefits within 30 days.
If you are approved for expidited/emergency SNAP: you will receive your beneifts within 7 days.
How do I find the status of my SNAP application?
You can check the status of your SNAP application:
I live with other people. Do I have put their names on my application?
If you live with roomates, and…
- you DO buy and prepare most of your food with the people you live with, you are considered a household. You WOULD apply together for SNAP as a household and WOULD put all their names on the application.
- DO NOT prepare most of your food together, you would apply as an individual, and would NOT put their names on the application.
Some people must always apply together, including spouses and children under 22 living with a parent or step-parent.
Do I have to go to the office to apply?
No. You can begin an application over the phone by calling Project Bread’s toll-free FoodSource Hotline at 1-800-645-8333.
You may also mail or fax your application to DTA or apply online at DTAConnect.org.
I am homeless. Can I apply for SNAP?
Yes. A permanent address is not required to apply for SNAP. You can get benefits whether you live on the street, are staying in a shelter, or are living with family or friends on a temporary basis. Homeless individuals and families who do not have regular shelter expenses can claim an automatic deduction from their income.
I am not a U.S citizen. Can I get SNAP?
Yes. Many non-citizens are eligible for SNAP. Receiving SNAP will have no impact on your application for citizenship and/or a green card. It is safe to apply for SNAP! If you do not have documented immigration status, you will not be able to apply for yourself, but you may be able to apply for other eligible household members. Children born in the US may receive benefits even if their parents do not have documentation. Learn more about SNAP benefits for immigrants.
I own my own home. Does that mean I cannot get SNAP?
No. In fact, the costs associated with owning your home are used as deductions in determining your eligibility.
Do I need to be working to apply for SNAP?
No. You do not need to be working in order to apply for or be eligible for SNAP.
What are emergency SNAP benefits? Who is eligible?
To be eligible for expedited benefits, you must meet one of these three criteria:
- Income and money in the bank add up to less than the monthly housing expenses
- Monthly income is less than $150, and money in the bank is less than $100
- The applicant is a migrant worker, and money in the bank is less than $100. If you are eligible for expedited, DTA has to issue you SNAP within 7 days from the date of your application – and make sure you have an EBT card within 7 days.
We suggest you call 1-877-382-2363 (press 7), go in person to your local DTA office, or go to DTAConnect.com to apply.
Do I have to use all my benefits before the end of each month?
No, SNAP benefits will remain on your EBT card for 274 days (9 months).
How to Apply for Emergency SNAP Benefits?
Emergency SNAP benefits are for SNAP applicants that need food assistance within 7 days. These benefits are typically issued for one month while applicants gather the verifications that the Department needs to approve a full SNAP application
Overview of emergency SNAP benefits
When you apply for SNAP benefits, case managers will screen you for SNAP eligibility and assess your household circumstances during the interview. Emergency SNAP benefits are issued if the applicant appears eligible and answers “yes” to one or more of the following questions:
- Does your income and money in the bank add up to less than your monthly housing expenses?
- Is your monthly income less than $150 and is your money in the bank $100 or less?
- Are you a migrant worker and is your money in the bank less than $100?
If you are approved for emergency SNAP benefits
Applicants who are eligible for emergency SNAP benefits will receive a letter confirming the amount they are eligible for. The letter will explain what verifications are needed to make a decision for ongoing SNAP benefits.
Like regular SNAP benefits, emergency SNAP benefits are issued on an Electronic Benefit Transfer (EBT) card. Applicants must use a Personal Identification Number (PIN) to use the emergency benefits.
If you are not approved for emergency SNAP benefits
If you are not approved for emergency SNAP benefits, you might still be eligible for monthly SNAP benefits.
If you have questions about why you were not eligible for emergency SNAP benefits, or you disagree with the decision, let the Department of Transitional Assistance know by contacting the DTA Assistance Line at (877) 382-2363.
If you are facing immediate hunger, your local food bank can provide information on pantries and local programs where you can get access to free food. Visit our website on how to find a local food bank.
How is SNAP Eligibility Determined
Eligibility is based primarily on household income and certain expenses. Learn more and see if you are eligible by calling Project Bread’s FoodSource Hotline at 1-800-645-8333.
Tenants' Rights In Massachusetts
What should I know about inspections?
Board of Health housing inspections are free. If you ask for an inspection, you should:
Be prepared. Before the inspection, fill out
the Housing Code Checklist:
www.masslegalhelp.org/Housing-Code-
Checklist
Clean your home. Make sure hallways and
doors are not blocked, and trash is taken out
so you do not get in trouble for Sanitary
Code violations.
Be there. If you cannot be there when the
inspector comes, arrange for someone else to
be there. Leave a note that says this person
has your permission to let the inspector
inspect your home.
Ask for a complete inspection. Ask for
inspection inside your apartment, outside of
the building, and all common areas.
Point out problems. If the inspector misses a
problem, point it out so it’s in the report.
Ask for a copy of the inspector’s report. If
your apartment or building needs serious
repairs, the inspector must send a repair order
to your landlord within 12 hours.
Follow up. If the landlord doesn’t make
repairs by the date and time on the order,
contact the inspector and ask for a re-
inspection.
For more assistance see: https://www.masslegalhelp.org/lt-repairs
What if my landlord refuses to make repairs?
If you told your landlord about a problem (it is best to do this in writing) or the landlord has been ordered by the Board of Health to make
repairs, and the landlord refuses to make repairs, you have the right to do these things:
Withhold rent or part of it until the landlord
makes the repairs. They may try to evict you.
To protect yourself from eviction, put the
rent money you withhold in a separate bank
account so you have this money if your
landlord takes you to court. Before you are
behind in rent, write your landlord a letter,
list the repairs needed, and say you will
withhold rent until the problems are fixed.
Keep a copy of your letter. See When You
Can Withhold Rent at
www.masslegalhelp.org/LL-refuses-repairs.
Repair and deduct. Get the repairs made
and deduct (subtract) the cost from your rent.
This can be complicated, and you must
follow the law, including getting a Board of
Health report.
Join with tenants. If other tenants need
repairs, work together on solutions.
Break your lease. If your landlord refuses to
fix serious problems, you may be able to
break your lease. This means moving out
before the end date on your lease and not
paying rent after you leave. You must get a
board of health inspection report first.
Take your landlord to court. If you prove
the landlord broke the law, a judge may order
them to make repairs or pay you money for
bad conditions. Or, the judge may order a
temporary landlord c
Can my landlord evict me if I ask for repairs?
No. It is illegal for a landlord to evict you, raise your rent, or make a major change in your rental agreement because you:
- Ask in writing for needed repairs,
- Report bad conditions in your apartment or building to the Board of Health orother local officials,
- Join a tenants’ organization, or Withhold rent because of bad conditions.
My apartment needs a repair. What can I do?
Tell your landlord as soon as possible. The
best way to do that is in writing (including
email). Your landlord must fix the problem
within a reasonable period of time.
Ask your landlord when a repair person
will come. It is important for you, or
someone, to be home so that the repair
person can get into the apartment.
If your landlord refuses to make the repairs,
you can call your city’s Board of Health to
ask for an inspection. A housing inspector will
examine your home to see if it follows the state
Sanitary Code. If there are violations, an
inspector can order your landlord to make
repairs within a certain time.
What types of problems is my landlord required to repair?
All tenants have the right to live in a safe and habitable place. You do not need a lease to have this right. If your landlord knows about a dangerous or unhealthy problem in your apartment or building and they don’t fix it, they are breaking the law.
The Massachusetts Sanitary Code sets minimum requirements for housing. For example, all rental housing must have heat, hot water, and electricity. Kitchens and
bathrooms must have sinks with running water. Unit doors and windows must have locks. If you have a more serious problem like no heat or hot water, the landlord must make a good faith effort to fix the problem within 24 hours of notice from a Board of Health.
