Massachusetts Medicaid Resources:

• State Medicaid Website: Massachusetts
• Massachusetts Developmental Disabilities Council Website
• The Arc of Massachusetts

Massachusetts Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 425,500 people with disabilities covered by Medicaid in Massachusetts. Massachusetts spent $10,641 on each Medicaid recipient with a disability in 2007.

30% of all people covered by Medicaid in Massachusetts have a disability, which is double the national percentage of 15%.

The state spends 43% of all the money it spends on Medicaid on services for people with disabilities, however, which is almost the same as the national percentage of spending on these services (42%).

Mass Health

This program is a statewide program that provides access to services for children and adults with disabilities. This program does not cover adults over 65, people who live in nursing or intermediate care facilities, or people who are Medicare dual eligible. This plan has a separate component that also includes comprehensive mental health and substance abuse disorder treatments and services for adults and children with disabilities.

Ages: 64 and under

• Community: transportation
• Health: chiropractic, dental, dialysis, CT scanning, early and periodic screening, diagnosis and treatment, durable medical equipment, hearing services and hearing aids, prosthetics and orthotics, immunization, MRIs, occupational therapy, outpatient hospital treatment, physical therapy, physician services, podiatry, skilled nursing facilities, speech therapy, vision, x-ray
• Home: home health care

Program of All-Inclusive Care for the Elderly (PACE)

PACE programs are designed for people 55 and older who need nursing home care, which might include many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary. Services are provided through PACE centers, so people must live close enough to an approved center to be eligible.

Ages: 55 and older

Level of Care: nursing

Restrictions: you must live close enough to access a PACE care center.

• Community: adult day care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs
• Home: home health care, home and environmental modifications
• Social Services: social services

Acquired Brain Injury waivers:

Massachusetts operates two waivers for people with acquired brain injury. One is a residential habilitation waiver, for people who need 24-hour supervision and support in a community-based residence. The other is a non-residential habilitation waiver, for people who can move into their own homes or into someone else’s home. These waivers are designed to help people move from nursing facilities into community-based living arrangements.

Restrictions: In order to be eligible clients must be living in a nursing facility. The brain injury must also have been acquired after age 22.

• Community: day service, transportation, transitional assistance
• Health: substance abuse treatment, occupational therapy, physical therapy, speech therapy, specialized medical equipment
• Home: residential habilitation
• Work: supported employment

Adult Residential waiver:

This waiver is for people with intellectual and developmental disabilities. This waiver helps people remain in home or community living arrangements but with 24-hour supervision and support even in the absence of natural supports.

Ages: 18 and older

Option for Self-Direction: This waiver offers options for people with disabilities to direct their own care, including managing your own 24-hour supervisor.

• Community: center-based day supports, day habilitation, peer support, transitional assistance, transportation
• Health: assistive technology, behavioral supports and consultation, occupational therapy, physical therapy, speech therapy
• Home: residential habilitation, respite, home modifications and adaptations, residential family training, self-directed 24-hour supports
• Work: supported employment

Adult Supports waiver:

This waiver is like the Adult Residential Waiver, except it is intended for people who can live in their own homes or in a family home with strong natural or informal supports.

Ages: 18 and older

• Community: community habilitation, transportation, group or center-based support
• Health: individual support, day habilitation
• Social Services: family support navigation
• Work: supported employment

Community Living waiver:

This waiver is for people with disabilities who can live in their own home or in someone else’s home and do not need 24-hour support. A wide variety of services are offered under this plan.

Option for Self-Direction: This program does let people direct some of their own services.

• Community: transportation, group day services, community family training, peer support, transitional services
• Health: individualized support, day habilitation, assistive technology, behavioral supports and consultation, occupational therapy, physical therapy, speech therapy, specialized medical equipment and supplies
• Home: homemaker services, live-in caregivers, respite, adult companions, chore services, home modifications and adaptations, vehicle modifications
• Work: supported employment

Traumatic Brain Injury waiver:

This waiver covers home and community-based services for individuals with traumatic brain injury.

• Health: residential habilitation
• Home: respite, environmental adaptations
• Work: supported employment