04. Who is eligible for ConnectorCare?

To be eligible for ConnectorCare, individuals must –

1. satisfy the federal eligibility criteria for purchasing a Qualified Health Plan (QHP) through the Health Connector; 
2. satisfy the federal eligibility criteria to qualify for Premium Tax Credits. (The Health Connector determines the amount of Advance Premium Tax Credits payable during the tax year, and the IRS determines the final amount of Premium Tax Credits (PTC) due when taxes are filed for the tax year after “reconciling” any amount received in advance), and 
3. individuals must have annual income at or under 300% FPL to qualify for the subset of QHPs that are ConnectorCare plans under state law. 

Each of these criteria is discussed further below and in later Q & As.

1. To be eligible to purchase a Qualified Health Plan (QHP) through the Health Connector individuals must be --
   • ​​​Residents of Massachusetts,
   • Not incarcerated at the time of enrollment, and
   • U.S. citizens or non-citizens who are “lawfully present” in the U.S. 
     • Lawfully present non-citizens include all legal permanent residents; there is no 5-year waiting period as there is for adults in MassHealth Standard or CarePlus. It also includes other categories of non-citizens who are not eligible for MassHealth Standard or CarePlus such as those with Temporary Protected Status, asylum applicants with work authorization and many others. A full list is in Appendix 2.
   • 45 CFR 155.305(a) (1)-(3)
2. To be eligible for an Advanced Premium Tax Credit an individual must --
   •  Have expected annual “Modified Adjusted Gross Income” (MAGI) over 100% FPL but not over 400% FPL
     •  EXCEPTION:  There is no minimum income for lawfully present noncitizens with income less than 100% FPL who are not eligible for MassHealth due to their immigration status.
   • Not be eligible for or enrolled in “minimum essential coverage,”
   • Not be eligible for or enrolled in employer-sponsored insurance that constitutes “minimum value” and  is considered “affordable” as those terms are defined by the ACA, and 
   • File a federal tax return with required forms for each year in which the individual receives an Advance Premium Tax Credit and, if “married” at the end of the tax year, files as married filing jointly unless the reason for filing as married filing separately is abuse or abandonment by the other spouse.
   • 45 CFR 155.305(f).
3. To also qualify for ConnectorCare, an individual must –
   • Have expected annual MAGI not in excess of 300% FPL, and
   • Enroll in a designated ConnectorCare plan.

956 CMR 12.04 and 12.08, and Health Connector Policy: Eligibility to Purchase Individual/Family Plan, Policy # NG-1A (2-12/16) Eligibility for Federal and State Financial Support for Individual/Family Plan, Policy # NG1B (4-21-16).​