130 CMR, § 519.001 - Introduction

(A) Categorical Requirements and Financial Standards. 130 CMR 519.000 explains the categorical requirements and financial standards that must be met to qualify for a MassHealth coverage type. The rules of financial responsibility and the calculation of financial eligibility are detailed in 130 CMR 520.000: MassHealth: Financial Eligibility.

(B) MassHealth Coverage Types. The MassHealth coverage types available to individuals aged 65 and older, institutionalized individuals, and those who would be institutionalized without community-based services are the following:

(1) MassHealth Standard;

(2) MassHealth Limited;

(3) Medicare Savings Programs (MSP) for Qualified Medicare Beneficiaries (QMB) (Senior Buy-In);

(4) Medicare Savings Programs (MSP) for Specified Low Income Medicare Beneficiaries and Qualifying Individuals (Buy-In);

(5) MassHealth CommonHealth; and

(6) MassHealth Family Assistance.

(C) Determining Eligibility. The MassHealth agency determines eligibility for the most comprehensive coverage available to the applicant, although the applicant has the right to choose to have eligibility determined only for MSP for Qualified Medicare Beneficiaries (QMB) or MSP for Specified Low Income Medicare Beneficiaries and Qualifying Individuals coverage. If no choice is made by the applicant, the MassHealth agency determines eligibility for all available coverage types.

Notes

130 CMR, § 519.001

Amended by Mass Register Issue 1327, eff. 12/2/2016. Amended by Mass Register Issue 1407, eff. 1/1/2020. Amended by Mass Register Issue 1409, eff. 1/1/2020. Amended by Mass Register Issue 1496, eff. 5/12/2023 (EMERGENCY). Amended by Mass Register Issue 1502, eff. 5/12/2023 (EMERGENCY). Amended by Mass Register Issue 1508, eff. 5/12/2023 (EMERGENCY). Amended by Mass Register Issue 1509, eff. 11/24/2023.