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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 Like every state's home and community-based services (HCBS) programs, Massachusetts Medicaid HCBS waivers are 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 Jul 17, 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. States cannot offer these services on their own; they need permission from the federal government, and the most common form of that permission is a section 1915(c) waiver.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 The waiver is what lets a state "waive" the usual rule that Medicaid long-term care happens in a nursing home, and instead pay for care where the person lives.
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 Jul 17, 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, without extra support at home, would likely end up in a nursing facility. It is administered jointly by MassHealth and the Executive Office of Aging & Independence, the state agency that was until recently called the Executive Office of Elder Affairs.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 The day-to-day work of assessing people and building their care plans happens through the Aging Services Access Points, or ASAPs, which are the regional agencies that cover every part of the state.
Here is how the pieces fit together. MassHealth handles the financial side and holds the federal waiver. The Executive Office of Aging & Independence oversees the program and the ASAP network. Your local ASAP is where you actually go: they conduct the clinical assessment, assign you a case manager, and put together the Comprehensive Service Plan that spells out which services you receive and how often.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
Who Qualifies for the Frail Elder Waiver
Four requirements have to line up for someone to qualify for the Frail Elder Waiver: age, clinical need, living situation, and finances.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 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 Jul 17, 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 at least one Frail Elder 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 Jul 17, 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 qualifying community setting under the federal CMS Community Rule, meaning your own home, a family member's home, or Congregate Housing. The waiver does not serve people living in assisted living residences, 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 Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 The state does not publish a single flat income or asset number for the Frail Elder Waiver on its applicant page, so 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. Covered services include 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036
You do not simply pick services off a menu. Your ASAP case manager works with you to build a Comprehensive Service Plan, which is the document that authorizes the specific mix of services you receive based on your assessed needs.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 As your situation changes, the plan can be revisited, which is one of the real advantages of having a case manager rather than a fixed benefit.
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 Jul 17, 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 Jul 17, 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. If you are 65 or older, though, you have another route, because you can receive your Frail Elder Waiver services through a Senior Care Options (SCO) plan instead.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 The Executive Office of Aging & Independence and its ASAP network handle this assessment and, if you qualify, assign your case manager.
For the financial track, you apply for MassHealth Standard the same way anyone applies for Medicaid coverage. Federal rules require the state to accept applications through several channels, including online, by phone, by mail, and in person.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, a Medicaid eligibility decision may not take more than 45 calendar days for most applicants, and no more than 90 calendar days when eligibility is based on a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf If you are close to either deadline without an answer, that is a reasonable point to follow up with MassHealth or your ASAP.
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, and it does not direct applicants to a standing waiting list on that page.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 How quickly things move on the ground can still vary with local capacity, though, which is exactly 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, which means your own home, a family member's home, or Congregate Housing, and specifically does not include assisted living residences, 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 Jul 17, 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 simultaneously with most of them. 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 There is one important exception: if you are 65 or older, you can receive your Frail Elder Waiver services through a Senior Care Options (SCO) plan, which combines your Medicare and MassHealth benefits under one plan.Centers for Medicare & Medicaid Services. (n.d.). MA Frail Elder Waiver (0059.R08.00) — State Waivers List, Medicaid.gov (CMS). medicaid.gov. Retrieved Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82036 The waiver brings the supports to your home; institutional MassHealth pays for care inside a nursing home. Our guide to Massachusetts Medicaid and nursing home care covers the institutional side in detail.
Learn More
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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.