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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

Income (SSI) program and determines the eligibility of disabled individuals. Individuals receiving SSI are automatically eligible for Standard coverage. Individuals without health insurance are provided choices of enrollment in a MassHealth managed care provider, SCO, or ICO in accordance with 130 CMR 508.000: MassHealth: Managed Care Requirements. (3) Health Connector. The Health Connector is Massachusetts’s health insurance marketplace where individuals, families, and small businesses can shop among qualified health insurance carriers and choose a health insurance plan. The Health Connector administers qualified health plans (QHPs), premium tax credits (PTC), and the ConnectorCare program. The single, streamlined application is used to determine eligibility for both Health Connector and MassHealth programs as described in 130 CMR 502.000: Health Care Reform: MassHealth: The Eligibility Process. The Health Connector and MassHealth also coordinate eligibility notices and eligibility appeals.

501.005: Individuals and Families Eligible for or Receiving Medical Assistance on June 30, 1997

(A) Members Who Were Not Subject to a Deductible. (1) Individuals and families (including caretaker relatives) who were receiving medical assistance on June 30, 1997, and whose family group gross income on June 30, 1997 exceeded MassHealth eligibility standards, will be provided Standard coverage for one year after the date of MassHealth implementation, except in the following circumstances: (a) the individual or family no longer lives in Massachusetts; (b) the individual enters an institution; (c) the individual turns 65 years old; (d) the individual or all members of the family are deceased; or (e) the individual or family is no longer categorically eligible. (2) Eligibility for continuing coverage will be reviewed toward the end of this one-year period.

(B) Families Who Have Met a Deductible. (1) Families (including caretaker relatives) with children younger than 18 years old who were receiving medical assistance on June 30, 1997, as a result of meeting a deductible, or who were denied with a deductible before July 1, 1997, and subsequently meet a deductible on or after July 1, 1997, and whose family group gross income exceeds MassHealth standards will be eligible for Standard for one year from the end of the deductible period, except in the following circumstances: (a) the individual or family no longer lives in Massachusetts; (b) the individual enters an institution; (c) the individual turns 65 years old; (d) the individual or all members of the family are deceased; or (e) the individual or family is no longer categorically eligible. (2) A determination of eligibility for MassHealth will be made toward the end of the one- year period.