Eligibility

Another helpful resource explaining the MAGI income methodology now being used in Massachusetts for most people under 65 in MassHealth and for people seeking subsidized insurance through the Connector

Fact sheet for calculating one-time deductible or spenddown for CommonHealth disabled people who are not working 40 hours or more a month.

Another great resource from the Center on Budget in D.C. to help advocates understand the new Modified Adjusted Gross Income (MAGI) methodology that will be used to determine eligibility for Medicaid for most adults under age 65 & eligibility for premium tax credits & other assistance…

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

This updated paper from MLRI describes changes in the methodology for determining income that were enacted as part of national health reform and how they will be implemented in MassHealth starting Jan. 1, 2014. The new tax-based methodology will affect most people on MassHealth except…

In this March 2014 Provider Bulletin, the Office of Medicaid summarizes the new coverage type for adults 21-64 with income under 138% FPL availalbe as of Jan. 2014

On January 1, 2014 a new type of MassHealth coverage became available called MassHealth CarePlus for adults age 21 to 65 with income at or below 133% of the poverty level and who are not eligible for Medicare. It is part of the expansion of the Medicaid program under federal health reform.…

A sample of the kind of notice sent to adults 21-64 with income under 138% FPL who have been determined eligible for CarePlus including notice of how to request a change to Standard based on special medical needs (being "medically frail")

Effective January 1, 2014, an extensive set of regulatory changes took effect in MassHealth related to implementation of the Affordable Care Act including the repeal of MassHealth Basic, Essential and the Insurance Partnership and creation of a new program called CarePlus along with many other…

Applicants for subsidized coverage to start on  Jan. 1, 2014 or later from MassHealth or the Connector for whom the broken computer system has been unable to make anl eligibility determination have instead been enrolled in MassHealth Standard Fee for Service coverage on a temporary basis until…

This Table from the June 2013 Roadmap to Coverage compares the benefits covered in MassHealth CarePlus with those covered in MassHealth Standard. Adults enrolled in CarePlus who need one or more services only available in Standard may be able to change their coverage to Standard if they have special…

New and easier way for U.S. Citizens to proven citizenship to MassHealthIn March 2011, MassHealth began verifying US citizenship through a data match with the Social Security Administration instead of requiring US citizen applicants to supply documents proving citizenship. If…

Letter from CMS to the states describing new category of "legally residing" immigrant pregnant women & children who can be treated as fully eligible for Medicaid 

Attached is a 2002 CMS publication describing rules enabling certain former SSI recipients to retain Medicaid/MassHealth as "deemed SSI" recipients when RSDI income exceeds Medicaid/MassHealth standards, and a Clearinghouse Review note explaining how to calculate whether one of these…

A recent fair hearing decision cited to this 1999 memo describing how MassHealth treats self-employment income including the limited situations where a net loss can offset other income.

MLRI has prepared a flyer on the MassHealth Breast & Cervical Cancer program --more affordable and comprehensive benefits for uninsured women AND women on Commonwealth Care or MassHealth Essential

The Office of Medicaid has revised the form to be used to request a record of Massachusetts birth from the Vital Statistics Office. The birth record will be sent back to the Office of Medicaid not the applicant. An applicant born in Mass. who needs a copy of the birth certificates can obtain it…

Revised on January 2, 2007. This is the revised version.

The federal Medicaid agency (CMS) has published interim final rules implementing the provision of the DRA requiring US citizens to verify citizenship & identity. Unlike earlier guidance, the rules exempt citizens who are SSI & Medicare recipients from having to prove citizenship. The…

This is the notice MassHealth mailed to members telling them about the July 1 2006 benefit improvements; more detailed information for providers and emergency rules are now or will soon be posted at https://www.mass.gov/topics/masshealth

This is the announcement MassHealth has prepared describing how it will implement a new federal law requiring US citizens applying for Medicaid after July 1, 2006 to verify that they are citizens

Changes in MassHealth effective July 1 include: restoration of optional benefits to adults; new smoking cessation benefit; increase in income eligibility for children & youth under age 19 to 300% of poverty, and implementation of federal rules requiring US citizens to verify citizenship &…

GBLS hearing memo which, after being sent to DMA Legal, led to DMA reversing its decision and approving the appellant's application. DMA had denied the application finding that the appellant, whose sole income is SSDI, was over the income limit when viewed as a household with her teenage daughter…

Updated 2007 version intentended for health care providers

Clarification of policy explaining how rental income is calculated in determing applicant household's MassHealth eligibility

The following information comes from Greater Boston Legal Services: Are you a Grandparent caring for your Grandchildren? You may be eligible for MASSHEALTH Have you been told you are not eligible for MassHealth because you are not a parent of minor children? Are you caring for your minor…

Subject: VICTORY!! Transitional Medical Assistance FIX and MassHealth for Non-Parent RelativesDMA AGREES TO FIX TMA AND PROVIDE MASSHEALTH TO SOME NON-PARENT CARETAKERSMarch 28, 2000A group of advocates from GBLS, MLRI, and Health Care for All met with the Division of Medical Assistance on March 27,…

Mass. Assoc. Older Americans (MAOA) v. Sharp, 700 F.2d 749 (1st Cir. 1983) reversing and remanding lower court order denying injunctive relief to plaintiffs whose Medicaid was terminated Contempt order upholding remedial order of lower court and finding that agency was in contempt.  803 F. 2d…

Additional Insurance Programs (including Healthy Start)