Massachusetts Medicaid, known as MassHealth, does pay for home and community-based care for older adults, and it delivers that care primarily through the Frail Elder Waiver.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 The Frail Elder Waiver is a home and community-based services (HCBS) waiver built on a federal authority called section 1915(c), which lets the state cover in-home supports for someone who meets the level of care for a nursing facility but would rather stay in their own home or a family member's home.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
In This Guide
- What Massachusetts Medicaid HCBS waivers are
- The Frail Elder Waiver in detail
- Who qualifies
- What it covers
- How enrollment works
- How to apply
What Massachusetts Medicaid HCBS Waivers Are, and the 1915(c) Rule Behind Them
Home and community-based services (HCBS) is the term Medicaid uses for long-term care delivered in your own home or community rather than inside an institution. Massachusetts' main program of this kind for older adults runs under a federal authority called a section 1915(c) waiver, which covers people who meet a nursing facility level of care but prefer to remain in the community.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
Massachusetts uses this authority to run the Frail Elder Waiver. The Centers for Medicare & Medicaid Services (CMS) approved the current version of the waiver in March 2024, and it is effective through March 2029 under CMS waiver number 0059.R08.00.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 That approval window matters mostly as reassurance: the program is a settled, federally sanctioned part of MassHealth, not a pilot that could disappear next year.
The Frail Elder Waiver: Massachusetts' Main Home Care Waiver
The Frail Elder Waiver is designed for older adults who meet the level of care for a nursing facility but prefer to remain in the community. Mass.gov files the program under MassHealth and the Executive Office of Aging & Independence (AGE), and applications and clinical eligibility assessments run through the statewide network of Aging Services Access Points, or ASAPs.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
Here is how the pieces fit together for a family. MassHealth decides financial eligibility directly. Your local ASAP is where the clinical side starts: it takes your application and runs the clinical eligibility assessment. Services are then delivered under a Comprehensive Service Plan developed with a case manager.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
Who Qualifies for the Frail Elder Waiver
Massachusetts lists seven eligibility criteria for the Frail Elder Waiver, and you have to meet all of them: age, clinical need, an ongoing need for waiver services, a qualifying community setting, being able to be served safely in the community within the waiver's terms, finances, and not being enrolled in a conflicting program.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
The age rule is the simplest. To qualify for the Frail Elder Waiver, you must be either 60 to 64 years old with a disability, or 65 or older.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
The clinical test is the heart of the waiver. You must meet the clinical eligibility requirements for a nursing-facility level of care, and you must need Frail Elder Waiver services; to stay eligible, you must keep receiving at least one waiver service each month. In plain terms, the state has to agree that your care needs are serious enough that you would otherwise qualify for a nursing home.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
Your living situation matters too. You have to live in a community setting that meets the federal CMS Community Rule, such as your own home or apartment, the home of a family member or caregiver, or Congregate Housing. That setting does not include assisted living, group homes, or rest homes, and participants cannot live in a nursing facility or other institution except for brief respite stays. You also have to be someone who can be safely served in the community within the terms of the waiver.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
On the money side, you must meet the requirements to qualify for MassHealth Standard in the community, and there are special financial rules that apply specifically to waiver applicants and participants. MassHealth determines this part directly.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 Because those special rules apply, the safest approach is to let MassHealth run your financial determination rather than assume a threshold. For the broader MassHealth income and asset picture, see our guide to MassHealth eligibility and income limits.
What the Frail Elder Waiver Covers
The Frail Elder Waiver pays for a wide set of supports meant to keep daily life manageable at home. Mass.gov lists 29 waiver services; among them are personal care, homemaker services, home health aide services, an adult day program known as the Supportive Day Program, respite so that a family caregiver can rest, home-delivered meals, transportation, environmental accessibility adaptations (the state's term for home modifications like ramps or grab bars), a personal emergency response system, and Alzheimer's and dementia coaching.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
You do not simply pick services off a menu. Waiver services are delivered under a Comprehensive Service Plan that a case manager develops with you for your specific services.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 Timing matters here: MassHealth cannot pay for waiver services delivered before a Comprehensive Service Plan for your specific services is developed and approved, so don't arrange paid services ahead of that approval and expect the waiver to cover them.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
How Enrollment Works
An eligible person can request to enroll in the Frail Elder Waiver at any time.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 There are two ways to start: contact your local Aging Services Access Point (ASAP) and ask for a clinical eligibility assessment, or complete an application and mail it to your local ASAP.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
One rule catches families off guard, so it is worth stating plainly: you cannot be enrolled in the Frail Elder Waiver at the same time as another HCBS waiver, a One Care plan, or a Program of All-Inclusive Care for the Elderly (PACE) plan. Senior Care Options (SCO) is not on that list. If you are 65 or older, you may be able to enroll in a SCO plan while in the waiver, and participants enrolled in SCO keep access to all waiver services plus everything their SCO plan offers.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 We cover those integrated plans in our guide to MassHealth SCO and One Care.
How to Apply for Massachusetts Medicaid HCBS Waivers
Applying for the Frail Elder Waiver has two tracks that run alongside each other: the clinical side through your ASAP, and the financial side through MassHealth.
For the clinical track, contact your local Aging Services Access Point to request the clinical eligibility assessment, or mail a completed application to that ASAP.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 Your services are later delivered under a Comprehensive Service Plan developed with a case manager.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
For the financial track, you apply to MassHealth for Standard coverage. Federal rules require the state to accept applications online, by phone, by mail, in person, and through other commonly available electronic means.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Because older adults usually apply on a basis other than the MAGI income standard, federal rules also let the agency use an application designed for that basis instead of the single streamlined form, so use the form MassHealth points you to.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Our step-by-step walkthrough lives in how to apply for MassHealth.
Once you have applied, there is a limit on how long the agency can take to decide. Under federal regulation, except in unusual circumstances such as a delay caused by the applicant or an examining physician, or an emergency beyond the agency's control, a Medicaid eligibility decision may not take more than 45 days for most applicants, and no more than 90 days for people who apply for Medicaid on the basis of disability.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 The longer window turns on the basis the application was filed under, not on whether a disability determination happens to arise, so an older adult applying on the basis of age sits on the 45-day standard. Both are outer limits on the agency rather than a promised decision date. The agency may not use them as a waiting period or as a reason to deny you, and if it does run late it must document why in your case record.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 If you are close to the limit that applies to you without an answer, that is a reasonable point to follow up with MassHealth.
Frequently Asked Questions
Is there a waiting list for the Frail Elder Waiver?
Massachusetts frames Frail Elder Waiver enrollment as open-ended: its applicant guidance says an eligible person may request to enroll at any time.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 That is a right to ask, not a promised start date, which is why it pays to begin the clinical assessment early. Starting sooner keeps your clinical and financial reviews progressing in parallel, so you are not waiting on paperwork at the moment care becomes urgent.
Can the Frail Elder Waiver pay for assisted living?
No. The Frail Elder Waiver requires you to live in a qualifying community setting under the federal CMS Community Rule, such as your own home or apartment, a family member's or caregiver's home, or Congregate Housing, and that setting does not include assisted living, group homes, or rest homes.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 If assisted living is where your family is headed, a different MassHealth pathway is the place to look.
Can I be in the Frail Elder Waiver and a PACE or SCO plan at the same time?
Not with PACE. A Frail Elder Waiver participant may not also be enrolled in another HCBS waiver, a One Care plan, or a Program of All-Inclusive Care for the Elderly (PACE) plan.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 SCO is different: if you are 65 or older, you may be able to enroll in a Senior Care Options (SCO) plan while in the waiver, and you keep access to all waiver services along with all services your SCO plan offers.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
How is the waiver different from MassHealth nursing home coverage?
Both serve people who meet a nursing-facility level of care, but the Frail Elder Waiver is for the person who meets that clinical bar and prefers to stay in the community rather than move into a facility.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 The waiver brings the supports to your home, and a participant cannot live in a nursing facility except for brief respite stays.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 Our guide to Massachusetts Medicaid and nursing home care covers the institutional side in detail.
Learn More
Find personalized help applying for the Frail Elder Waiver at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.
Still have questions?
Brevy answers from this guide and every other guide here, and can check what you qualify for.