Understanding immigrants' eligibility for MassHealth & other subsidized coverage, March 2024

This  updated March 2024 memo summarizes the current immigrant eligibility rules that MassHealth and the Health Connector use in making decisions about what kinds of coverage non-citizens with different kinds of status can receive.

The update reflects federal law changes in 2021 and 2022 regarding benefit eligibility for Afghans and Ukrainians granted humanitarian parole within certain dates.  It includes Appendices listing different categories of immigrants eligible for different kinds of benefits under health program rules. Two tables summarize the information. It includes citations to state & federal regulations along with links to other resources.

If you know a client's immigration status, use the Find function to see in which Appendix that kind of status is shown, then use the information about whether the status is Qualified, Qualified Barred, Non-Qualified Lawfully Present or PRUCOL in Table 2 to see what kinds of health benefits  the individual may be able to receive based on their immigration status and other factors shown on the Table.  

November 1, 2024 Update applicable to the Health Connector

Expanded definition of lawful presence for the Health Connector effective Nov 1, 2024. 

A new federal regulation applicable to the Marketplace (the Health Connector) expands the definition of lawfully present immigrants effective Nov 1, 2024. 45 CFR 152.2. The Connector eligibility regulations cross-reference to this federal regulation to define lawful presence. 956 CMR 12.04.  Non-citizens must be “lawfully present” under the Marketplace definition to shop for private coverage through the Health Connector or to qualify for ConnectorCare or Advanced Premium Tax Credits (APTCs). The following groups were added to the federal definition:

• Deferred Action for Childhood Arrivals (DACA); most will have C33 on their work permits,
• Applicants for asylum who are age 14 or younger with an application pending for fewer than 180 days,
• Certain employment-based non-immigrants and dependents with C35 or C36 on their work permits,
• Individuals with a pending application for adjustment who do not have an approved visa petition because it was not required,
• Family Unity beneficiaries under the LIFE Act, and
• Individuals granted Special Immigrant Juvenile (SIJ) status.

No change to MassHealth definition of lawful presence or PRUCOL.

The federal Medicaid regulations governing MassHealth have not changed. MassHealth has not made any change to its definition of lawful presence. However, anyone on the list above who is not now treated as lawfully present under MassHealth rules, like DACA and young people with asylum applications pending for less than 180 days, will still be treated as PRUCOL. MassHealth is not changing its PRUCOL regulations.

Practical considerations

MassHealth and the Health Connector use an integrated application system called HIX,  and in order to qualify for ConnectorCare or APTC-only coverage, applicants must be ineligible for any type of MassHealth except MassHealth Limited.  Individuals, such as DACA recipients, with income of 300% of the poverty level or less who are now eligible for MassHealth Family Assistance as PRUCOL, will still be eligible after Nov 1, 2024. MassHealth rules have not changed. However, now DACA recipients with income over 300% of the poverty level -- income too high to qualify for Family Assistance-- will be able to qualify for the Health Connector. ConnectorCare now goes up to 500% of the poverty level and  APTC-only coverage has no upper income limit in 2025. They can also now use the Connector to shop for private insurance at full cost.  The same is true for the other groups affected by the new rule.

The new rule has not been programmed into the HIX eligibility system. When DACA recipients apply, the system will not be able to verify an eligible immigration status for them automatically. If their income is too high for MassHealth, the system will deny them coverage from the Connector in real time. However, Connector staff will be implementing a workaround overnight, to suppress the denial and apply the new rule on lawful presence to those who qualify.