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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

or (3) if the child spends an equal number of nights with each parent, it is determined by the Internal Revenue Service (IRS) tax rules.

Day. A calendar day unless a business day is specified.

Deductible. The total dollar amount of incurred medical expenses that an applicant, whose income exceeds MassHealth income standards, must be responsible for before the applicant is eligible for MassHealth as described at 130 CMR 506.009: The One-time Deductible.

Deductible Period. A specified six-month period within which an applicant for MassHealth, whose income exceeds MassHealth income standards, may become eligible, based on disability, through incurred and/or paid medical expenses of the applicant or any member of the MassHealth Disabled Adult Household as described in 130 CMR 506.009: The One-time Deductible.

Disability Evaluation Services (DES). A unit that consists of physicians and disability evaluators who determine permanent and total disability of an applicant or member seeking coverage under a MassHealth program for which disability is a criterion, using criteria established by the Social Security Administration (SSA) under Title XVI and criteria established under state law. This unit may be a part of a state agency or under contract with a state agency.

Disabled. Having a permanent and total disability as defined in Title XVI of the Social Security Act.

Disabled Adult Household. See 130 CMR 506.002(C): MassHealth Disabled Adult Household.

Disabled Working Adult. A person who is engaged in substantial gainful activity but otherwise meets the definition of disabled, as defined in Title XVI of the Social Security Act.

Duals Demonstration Dual Eligible Individual. For purposes of the Duals Demonstration Program, a MassHealth member must meet all of the following criteria: (1) be 21 through 64 years old at the time of enrollment; (2) be eligible for MassHealth Standard as defined in 130 CMR 450.105(A): MassHealth Standard or MassHealth CommonHealth as defined in 130 CMR 450.105(E): MassHealth CommonHealth; (3) be enrolled in Medicare Parts A and B, be eligible for Medicare Part D, and have no other health insurance that meets the basic-benefit level as defined in 130 CMR 501.001; and (4) live in a designated service area of an ICO.

Duals Demonstration Program. The MassHealth state Demonstration to Integrate Care for Duals Demonstration Dual Eligible Individuals.

Eligibility Process. Activities conducted for the purposes of determining, redetermining, and