Children's Health Including Children's Medical Security Plan

Attached is MLRI's March 1, 2024 Table upper income limits in MassHealth, MSP, Health Safety Net, CMSP and ConnectorCare, along with the Nov 1 2024 Table (updated Jan 30, 2025) showing the updated income limits for ConnectorCare coverage in 2025; open enrollment for 2025 begins on Nov 1,…

On March 18, the Families First Coronavirus Response Act was enacted. It prohibited states from ending coverage for Medicaid beneficiaries enrolled on March 18, 2020 or later and continuing until the end of the COVID-19 emergency. CMS has issued two sets of FAQs for the states with more…

Attached are updated income tables for 2020 showing the upper income limits in MassHealth and Other Health programs. One table is the MassHealth Desk Guide showing the annual and monthly amounts that correspond to different percentages of the federal poverty level used by MassHealth; the 5%…

Medicaid's "Early and Periodic Screening, Diagnosis and Treatment" (EPSDT) benefit for children is a powerful tool advocates can use to help children and youth under age 21 enrolled in MassHealth Standard or CommonHealth get the health benefits they need. This memo provides citations…

Attached are updated income tables for 2019 showing the upper income limits in MassHealth and Other Health programs. One Table is the MassHealth Desk Guide showing the annual and monthly amounts that correspond to different percentages of the federal poverty level used by MassHealth; the 5% of FPL…

MassHealth is proposing updating its premium and copayment charges by Jan. 2019.  This paper looks at what MassHealth's proposal to base premiums on 3% of family income for families with income over 150% of poverty will mean for children with income between 150-300% of poverty. 

Federal funding for the Children's Health Insurance Program expired on September 30, 2017.  Massachusetts and other states are continuing to operate their programs using unexpended prior funding, but this is rapidly running out.  Funding in Massachusetts could be exhausted sometime in…

Attached are two recent letters signed by Gov Baker. One letter dated May 11, 2017 is from the National Governor's Association, co-signed by Gov Baker as vice chair  of the Health & Human Services Committee  to Congressional leaders urging them to reauthorize funding for the…

A group of orthodontist & their patients sued MassHealth for having unduly restrictive medical necessity criteria for approving braces for children & youth under age 21. The case resulted in a settlement changing MassHealth policies. Attached is a copy of a Jan 2016 transmittal letter making…

The Autism Omnibus Act requires MassHealth to cover medically necessary ABA services for children with autism under age 21.  ABA services are now available to MassHealth members. The attached “Frequently Asked Questions” explain how to get coverage now through the…

The Centers for Medicare & Medicaid Services (CMS) has just published a Guide to the Early Periodic Screening, Diagnosis and Treatment benefits for children and youth under age 21 in Medicaid. The 38 page EPSDT Guide was written in collaboration with the National Health Law…

Short summary of 2014 changes affecting the eligibility of children and young adults for MassHealth with citations to the state regulations.

This website is maintained by the Center for Public Representation. It includes up to date information about the implementation of the Rosie D. class action regarding mental health screening and services for children receiving MassHealth. It also includes copies of the litigation documents.

Early Intervention (EI) in MA is a statewide, integrated, development service available to families of eligible infants and toddlers.  Family-centered services are provided under federal and state law to help children progress in their development and to enhance a family’s ability to meet…

Click the "Go to Website" link below to access the CMSP website.  The Children's Medical Security Plan is a program funded by MassHealth and administered by UniCare.

Access to Home-Based Mental Health Services Rosie D. v. Patrick and the Children’s Behavioral Health Initiative (CBHI) For an overview of home-based behavioral health services for children available through MassHealth and how to access them, including providers by region, see:…

Link to the Boston Bar Association for a copy of the third edition of this guide to mental health services for children.  According to the BBA, "[t]he Guide is designed to help parents in Massachusetts find the child mental health services and resources their children need.Practical…

Webpage on the mass.gov website with links to information on CBHI, including eligibility criteria, services available and listings of Community Service Agencies (CSA). 

Even though the office of Medicaid has not yet published regulations on the matter, under the provisions of the Children's Health Insurance Program Reauthorization Act (CHIPRA) various classes of AWSS immigrants (five year barred immigrants) have been upgraded to better programs for health…

The Massachusetts Medicaid Policy Institute has released a new policy paper looking at the opportunities and challenges faced in the implementation of Rosie D. v. Romney lawsuit. This issue brief explores the implications and potential effects of the case and the resulting proposed remedy on the…

Summary of the rights of children under age 21 to early, periodic screening, diagnostic and treatement (EPSDT) services under Medicaid (MassHealth). UPDATE: Please note the address of the Board of Hearings has changed since the attached Memo was written. The address of the MassHealth Board of…

From the preface: "This guide is designed for healthcare providers, social service agency employees, and other practitioners who connect young people with the medical care they need. While the age of consent for all medical treatment in Massachusetts is generally 18, those younger than 18…

A summary of the US District Court's 98 page opinion in Rosie D. v. Romney. For copies of the decisions, as well as pleadings, memoranda and other papers filed in connection with the litigation, go to the Rosie D website, www.rosied.org

Parties' briefs for summary judgment in dental case. State claims no private cause of action to enforce Medicaid Act. Argued 07/12/2004. On Oct 2, 2004 J. Zobel made her decision on 5 counts under the Medicaid Act 42 USC 1396a. For each count the issue was whether Congress intended used…