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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

501.003: MassHealth Coverage Types

(A) The MassHealth agency provides access to health care by determining eligibility for the coverage type that provides the most comprehensive benefits for an individual who may be eligible.

(B) MassHealth offers several coverage types: Standard, CommonHealth, CarePlus, Family Assistance, and Limited. The coverage type for which a person is eligible is determined based on the individual's income and circumstances, as described in 130 CMR 503.000: Health care Reform: MassHealth: Universal Eligibility Requirements through 505.000: MassHealth: Health care Reform: Coverage Types, and immigration status, as described in 130 CMR 504.000: Health Care Reform: MassHealth: Citizenship and Immigration.

(C) The MassHealth agency may limit the number of people who can be enrolled in Family Assistance. When the MassHealth agency imposes such a limit, no new adult applicants (21 years of age or older) subject to these limitations will be added to Family Assistance, and current adult members in these coverage types who have lost eligibility for more than 30 days for any reason will not be allowed to reenroll until the MassHealth agency reopens enrollment for adults in Family Assistance.

501.004: Administration of MassHealth

(A) MassHealth. The MassHealth agency formulates requirements and determines eligibility for all MassHealth coverage types.

(B) Other Agencies. (1) Department of Transitional Assistance (DTA). (a) The DTA administers the Transitional Aid to Families with Dependent Children (TAFDC) Program. Persons who meet the requirements of § 1931 of Title XIX (42 U.S.C. § 1396u-1) are automatically eligible for Standard coverage. (b) DTA also administers the Emergency Aid to the Elderly, Disabled and Children (EAEDC) Program. The MassHealth agency provides MassHealth to those persons receiving EAEDC cash assistance as follows: 1. MassHealth Standard: children younger than 19 years old, ; young adults 19 and 20 years old who are citizens, qualified noncitizens, qualified noncitizens barred, and nonqualified individuals lawfully present; parents and caretakers who are citizens or qualified noncitizens; adults 21 through 64 years old who are citizens or qualified noncitizens; children younger than 19 years old; 2. MassHealth Family Assistance: children younger than 19 years old, young adults 19 and 20 years old who are nonqualified persons living under color of law (PRUCOLs), parents and caretakers who are qualified noncitizens barred, nonqualified individuals lawfully present, nonqualified PRUCOLs, and adults 21 through 64 years old who are qualified noncitizens barred, nonqualified individuals lawfully present, and nonqualified PRUCOLs. (2) Social Security Administration (SSA). The SSA administers the Supplemental Security