Paying for a nursing home with MassHealth

Facts checked 29 September 2026 · next check January 2027

The numbers

Who qualifies

The person must need nursing-home level care (a clinical screening confirms this) and have no more than $2,000 in countable assets. Countable assets include bank accounts, CDs, stocks, most retirement accounts and second homes. The home you live in is treated separately (see below).

Once on MassHealth, the resident pays most of their monthly income to the nursing home. This is called the Patient Paid Amount. MassHealth pays the rest.

• The resident keeps $72.80 a month for personal needs.
• Health insurance premiums (for example Medicare Part B or a Medigap policy) can be deducted.
• If there is a spouse at home, part of the resident's income can go to that spouse (see next section).

Protection for a husband or wife at home

MassHealth adds up both spouses' countable assets, no matter whose name they are in. The spouse at home may keep the combined total up to $162,660 in 2026. Anything above that, plus the resident's $2,000, must be spent down or otherwise dealt with before MassHealth pays.

If the spouse at home has little income of their own, they can be allowed part of the resident's income to bring them up to at least $2,705 a month (from July 1, 2026), and in some cases up to $4,066.50 when housing costs are high. A fair hearing can raise these amounts in exceptional cases.

The house

The home is not counted while you, your spouse, or certain relatives live there, as long as your equity in it is no more than $1,130,000 in 2026. The equity limit does not apply if a spouse, or a child under 21 or a blind or disabled child, lives there.

If a single person moves into a nursing home, the home is still not counted if they intend to return home. It becomes a countable asset only if they move out without the intent to return and none of the protected relatives live there. Protected relatives are a spouse; a child under 21 or blind or disabled; a sibling with an ownership share who lived there at least a year before admission; a son or daughter who lived there at least two years and whose care kept the parent at home; or a dependent relative.

MassHealth can place a lien on real estate owned by a nursing-home member. If a home must be sold, MassHealth normally allows nine months to sell it at fair market value, extended while there is a good-faith effort to sell.

The five-year look-back and the gift penalty

When you apply, MassHealth looks at every transfer made in the previous 60 months. Money or property given away, or sold for less than it was worth, can cause a period when MassHealth will not pay for nursing home care.

The penalty is worked out by dividing the value given away by the average daily private cost of a Massachusetts nursing home — $450 a day for applications received on or after November 1, 2025. For example, a $45,000 gift would mean about 100 days of no coverage. The penalty does not start until the person is in the nursing home and otherwise eligible, so it cannot simply run out in the background.

• Some transfers are allowed, for example transfers between spouses, and the home can go to certain relatives such as a caregiver child who lived there for two years.
• Keep receipts and records for large withdrawals and payments to family members; MassHealth will ask.

Estate recovery

After a MassHealth member dies, MassHealth may seek repayment from their probate estate for care it paid for after age 55, or at any age while the member was permanently in a nursing home.

MassHealth does not pursue estates worth $25,000 or less. Recovery is delayed while a surviving spouse is alive, or while there is a child under 21 or a blind or disabled child. Hardship waivers exist for some heirs, including those who lived in the home and gave care.

How to apply

Use the Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (form SACA-2). You can complete it online, mail it to MassHealth Enrollment Center, Central Processing Unit, P.O. Box 290794, Charlestown, MA 02129-0214, or fax it to (617) 887-8799. The nearest MassHealth Enrollment Center to Cape Cod is in Taunton.

Have ready: Social Security numbers, proof of income, statements for all accounts (MassHealth may ask for up to five years of statements), deeds, life insurance policies and any health insurance cards. Coverage can start up to three months before the month you apply if the person was otherwise eligible.

Mistakes families make

• Giving money or the house to children without understanding the five-year look-back; the penalty begins only when the person applies and is otherwise eligible.
• Assuming the house will be taken. The home is often protected while a spouse lives there, or if the resident intends to return home.
• Spending down without keeping receipts. Unexplained withdrawals can be treated as gifts.
• Forgetting that the spouse at home is protected. Couples sometimes spend savings the at-home spouse was allowed to keep.
• Waiting too long to apply. Coverage can reach back only three months before the month of application.

Who to call on Cape Cod

This page explains the rules; it is not legal advice. For your own situation, talk to an elder law attorney or SHINE.