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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 251 Rev. 02/13/2026

130 CMR 501.000: HEALTH CARE REFORM: MASSHEALTH: GENERAL POLICIES

Tax Dependent. A qualifying child or qualifying relative, other than the taxpayer or spouse, who entitles the taxpayer to claim a dependency exemption. An individual who files a return but is claimed as a dependent by someone else is still a tax dependent.

Tax Filer. Any individual, including their spouse if married filing jointly, who intends to file a federal tax return for the year in which a member of the tax household is seeking or receives benefits and who claims an exemption for themselves. An individual who files a return but is claimed as a dependent by someone else is still a tax dependent.

Tax Household. All members who are claimed on the tax return, including the tax filer(s) and all dependents.

Third Party. Any person, entity, or program that is or may be responsible for paying all or part of the expenditures for medical benefits.

Young Adult. An individual 19 or 20 years old.

501.002: Introduction to MassHealth

(A) The MassHealth agency is responsible for the administration and delivery of MassHealth services to eligible low- and moderate-income individuals, couples, and families.

(B) 130 CMR 501.000: MassHealth: General Policies through 130 CMR 508.000: MassHealth: Managed Care Requirements provide the MassHealth requirements for children, young adults, parents and caretaker relatives, adults, people who are pregnant, disabled persons, persons who are HIV positive, individuals with breast or cervical cancer, and certain other individuals or couples who are younger than 65 years old and not institutionalized. These requirements are prescribed in accordance with all applicable laws, including Title XIX and Title XXI of the Social Security Act, and MassHealth’s 1115 Medicaid Research and Demonstration Waiver.

(C) 130 CMR 515.000: MassHealth: General Policies through 130 CMR 522.000: MassHealth: Other Division Programs provide the MassHealth requirements for persons who are institutionalized, 65 years of age or older, or who would be institutionalized without community- based services in accordance with all applicable laws, including Title XIX of the Social Security Act.

(D) The MassHealth agency will determine eligibility for low-income subsidies under Medicare Part D, as set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and as described in federal regulations at 20 CFR Part 418.