MassHealth Family Assistance provides coverage for different groups including 100% state-funded coverage for certain lawfully present and PRUCOL immigrants who are not eligible for federally reimbursed Medicaid. Until recently, Family Assistance included few long term services and supports. MassHealth expanded the Family Assistance benefit in July 2020 and again on Nov 1, 2021. Also on Nov 1, 2021 it created a new pathway for elderly and disabled immigrants previously only eligible for state-funded Family Assistance to now obtain state-funded MassHealth Standard.
The July 2020 Changes to Family Assistance:
In July 2020 MassHealth expanded the benefits of Family Assistance to include up to 100 days of Nursing Facility services and up to100 days of service in a Chronic Rehabilitation Hospital. (Prior to July 1, 2020 only 30 days in a Chronic Disease Hospital and no Nursing Facility days had been covered in Family Assistance). The Provider Bulletins describing the July 2020 changes were: July 2020 Nursing Facility Provider Bulletin 149 and Chronic Disease and Rehab Inpatient Hospital Provider Bulletin 90 authorizing the 100 day benefit expansion of Family Assistance. They have since been superseded to reflect the Nov 1, 2021 expansion
The Nov 1, 2021 Changes to Family Assistance and creation of state-funded MassHealth Standard
In October 2021 MassHealth announced it will be expanding Family Assistance to include up to 6 months of Nursing Facility services effective Nov 1, 2021 It also announced that it will be providing the full range of community and facility-based long term services and supports available in MassHealth Standard and CommonHealth to medically eligible state-funded immigrants effective Nov 1, 2021. Attached is the November 2021 Eligibility Operation Memo 21-26 Pathway to Short-Term and Long-Term Care for Family Assistance Members .So far, the agency has developed an assessment form for use by the ASAPs to determine when Family Assistance members meet the Nursing Home Level of Care (attached). Those who meet the Nursing Facility level of care may qualify for state-funded MassHealth Standard which they can use to pay for a long term stay in a nursing facility or Chronic Disease/Rehab Hospital OR they can use the full range of MassHealth Standard benefits available in the community. We are awaiting further guidance on how individuals who do not meet a Nursing Facility LOC but do meet the clinical criteria for Personal Care Attendant (PCA) services can qualify for state-funded MassHealth Standard.
Additional Guidance release since Nov 1, 2021
On Dec 3, 2021 MassHealth released a more detailed Eligibility Policy Update of the Nov 2021 policy change attached as the "New LTSS Pathways External Summary"
In Jan 2022 MassHealth released provider bulletins regarding short term and long term care in a Chronic Disease Hospital or Nursing Facility superseding the earlier July 1, 2020 Bulletins
- Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 97: Family Assistance Coverage Expansion for MassHealth Chronic Disease and Rehabilitation Hospitals – Updated
- Nursing Facility Bulletin 174: Family Assistance Coverage Expansion for Nursing Facility Services – Updated
We will post further Provider Bulletin and other related documents on the Nov 1 expansion when they become available.