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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

maintaining the eligibility of a MassHealth applicant or member.

Fair Hearing. An administrative, adjudicatory proceeding conducted according to 130 CMR 610.000: MassHealth: Fair Hearing Rules to determine the legal rights, duties, benefits, or privileges of applicants and members.

Family Group. A family, couple, or individual.

Federal Poverty Level (FPL). Income standards issued annually in the Federal Register to account for the last calendar year's increase in prices as measured by the Consumer Price Index. MassHealth within its discretion updates the FPL standards accordingly each year in March.

Fee-for-service. A method of paying for medical services provided by any MassHealth participating provider with no limit on provider choice.

Filing Status. An Internal Revenue Service term. The five filing statuses are single, married filing a joint return, married filing a separate return, head of household, and qualifying widow(er) with dependent children. The rate at which income is taxed is determined by the filing status.

Gross Income. The total money earned or unearned, such as wages, salaries, rents, pensions, or interest, received from any source without regard to deductions.

Health Insurance. Coverage of health care services by a health insurance company, a hospital- service corporation, a medical-service corporation, a managed care organization, or Medicare. Coverage of health care services by MassHealth, Health Safety Net, or Children’s Medical Security Plan (CMSP) is not considered health insurance.

Health Safety Net. A source of funding for certain health care under 101 CMR 613.00: Health Safety Net Eligible Services and 101 CMR 614.00: Health Safety Net Payments and Funding.

Hospital-determined Presumptive Eligibility. The MassHealth agency will provide time-limited coverage, in accordance with 130 CMR 502.003(H): Hospital-determined Presumptive Eligibility, for individuals who are determined to be presumptively eligible by a qualified hospital, as defined at 130 CMR 450.110(B).

Incarceration. The confinement in a penal institution of an individual. An individual is not incarcerated if they are on parole, probation, or home release, and do not return to the institution for overnight stays.

Inconsistency Period. The time frame that an individual has to provide verifications needed to determine eligibility for health insurance offered by the Connector.

Integrated Care Organization (ICO). An organization with a comprehensive network of medical,