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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

Massachusetts Health Connector, and as are in effect on the first day coverage under that plan begins.

(2) Exceptions (a) For the avoidance of doubt, instruments including but not limited to Health Reimbursement Arrangements, Flexible Spending Arrangements, as described in IRS Pub. 969, or Health Savings Accounts, as described at IRC § 223(c)(2), cannot be used to reduce the health insurance deductible in order to meet the basic-benefit level requirement. (b) The MassHealth agency reserves the right to set its own annual deductible and maximum out-of-pocket limits. If the MassHealth agency deems it appropriate to set its own annual deductible and maximum out-of-pocket limits, a sub-regulatory bulletin will be issued.

Behavioral Health Contractor. The entity contracted with EOHHS to provide, arrange for, and coordinate behavioral health care and other services to members on a capitated basis.

Blindness. A visual impairment, as defined in Title XVI of the Social Security Act. Generally, Blindness means visual acuity with correction of 20/200 or less in the better eye, or a peripheral field of vision contracted to a 10° radius or less, regardless of the visual acuity.

Business Day. Any day during which the MassHealth agency’s offices are open to serve the public.

Caretaker Relative. An adult who is the primary care giver for a child; is related to the child by blood, adoption, or marriage; or is a spouse or former spouse of one of those relatives, and who lives in the same home as that child, provided that neither parent is living in the home.

Case File. The written collection of documents and information required to determine eligibility and to provide benefits to applicants and members.

Certified Application Counselor (CAC). An individual who is certified by the MassHealth agency and the Connector to provide assistance in completing applications and renewal forms.

Child. A person younger than 19 years old.

Citizen. See 130 CMR 504.002: U.S. Citizen.

Commonwealth Health Insurance Connector Authority or Health Connector or Connector. The entity established pursuant to M.G.L. c. 176Q § 2.

ConnectorCare. The program administered by the Health Connector pursuant to M.G.L. c. 176Q to provide premium assistance payments and point-of-service cost-sharing subsidies to eligible