Cost Share Guidelines for Home Care
Home care services are open to all. Some have specific eligibility requirements related to residency, age and functional needs.
Any older adult or individual with a disability is eligible for a free in-home assessment and information based on community resources and their specific needs. Cost share amounts for supportive services through the Home Care program are determined based on income.
Cost Share Guidelines:
Age & Residence
60 years and older or under 60 with a diagnosis of Alzheimer's disease and in need of respite services. Consumers must be living at home in Massachusetts and not in an institutional setting or Assisted Living Residence.
Financial
MassHealth members are financially eligible. Income guidelines require Annual Gross Income less than $2,901.00/month or $34, 812.00/year in calendar year 2025.
Monthly Co-payments
$10 - $141 for individuals with incomes that range from $15,848-$35,601
$14 - $199 for two person (married) income that range from $21,342-$50,374
See specific cost-share schedules below.
Percent Based Co-payment: (For those with a higher income than those listed above.)
50% - 100% of the cost of services received monthly, based on a person's individualized care plan.
See specific cost-share schedules below.
Note on Percent Based Co-payment: Each person's care needs are different and can change based on a variety of factors. This can affect the type of services necessary to support care needs and the cost of services. A regional elder care agency, that works in partnership with the State Home Care Program, will work with you to access services based on your care needs and goals.
Voluntary Co-Payment and Cost Sharing Schedules
Issue Date: 2/25/25
Effective Date: 3/28/25
Voluntary Co-Payment:
Family Size Annual Gross Income Voluntary Monthly Co-Payment
1 $15,847 or less $10.00
2 $21,341 or less $14.00
Family Size Annual Gross Income Voluntary Monthly Co-Payment
Cost Sharing - Maximum Fixed Monthly Amount Based on Services Received During the Month:
One Person Annual Gross Income Monthly Co-payment Two Person Family Annual Gross Income Monthly Co-payment
$15,848 - $19,100 $10.00 $21,342 - $26,324 $14.00
$19,101 - $22,537 $13.00 $26,325 - $31,641 $18.00
$22,538 - $24,892 $27.00 $31,642 - $34,318 $40.00
$24,893 - $26,673 $39.00 $34,319 - $36,988 $55.00
$26,674 - $28,451 $49.00 $36,989 - $39,665 $68.00
$28,452 - $30,225 $69.00 $39,666 - $42,345 $96.00
$30,226 - $32,006 $90.00 $42,346 - $45,014 $126.00
$32,007 - $33,778 $125.00 $45,015 - $47,694 $176.00
$33,779 - $35,601 $141.00 $47,695 - $50,374 $199.00
One Person Annual Gross Income Monthly Co-payment Two Person Family Annual Gross Income Monthly Co-payment
MassHealth Members whose income is below $33,948 (300% FBR) do not have a co-pay
Cost Sharing - Percent Co-Payment Based on Cost of Services Received During the Month:
One Person Annual Gross Income Monthly Co-payment Two Person Family Annual Gross Income Monthly Co-payment
$35,602 - $38,575 50% $50,375 - $52,080 50%
$38,576 - $41,467 55% $52,081 - $54,970 55%
$41,468 - $44,363 60% $54,971 - $57,867 60%
$44,364 - $47,255 65% $57,868 - $60,758 65%
$47,256 - $50,146 70% $60,759 - $63,651 70%
$50,147 - $53,044 75% $63,652 - $66,543 75%
$53,045 - $55,931 80% $66,544 - $69,438 80%
$55,932 - $58,826 85% $69,439 - $72,329 85%
$58,827 - $61,726 90% $72,330 - $75,222 90%
$61,727 - $64,614 95% $75,223 - $78,117 95%
$64,615 - and over 100% $78,118 - and over 100%
One Person Annual Gross Income Monthly Co-payment Two Person Family Annual Gross Income Monthly Co-payment
Call (800) 243-4636 for additional information.
Additional Resources
No comments:
Post a Comment