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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

Medical Benefits. Payment for health insurance or medical services provided to a MassHealth member.

Member. An individual determined by the MassHealth agency to be eligible for MassHealth.

Modified Adjusted Gross Income (MAGI). Modified adjusted gross income as defined in section 36(B)(d)(2) of the Internal Revenue Code with the following exceptions: (1) an amount received as a lump sum only counts as income in the month received; (2) scholarships, awards, or fellowship grants used for education purposes and not for living expenses are excluded from income; (3) certain taxable income received by American Indians and Alaska Natives is excluded from income as described in 42 CFR § 435.603(e).

Navigator. An individual who is certified by the Health Connector to assist an applicant with electronic and paper applications to establish eligibility and enroll in coverage through the Health Connector. In addition, a navigator provides outreach and education about insurance options offered through the Health Connector.

Nonqualified Individuals Lawfully Present. See 130 CMR 504.003(A)(3): Nonqualified Individuals Lawfully Present.

Nonqualified Person Residing under Color of Law (Nonqualified PRUCOLs). See 130 CMR 504.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs).

One-adult-with-one-child Policy. A health insurance policy that covers a family consisting of one adult and one child.

Other Noncitizen. See 130 CMR 504.003(D): Other Noncitizens.

Parent of a Child Younger than 19 Years Old. Natural, adoptive, or stepmother or stepfather of a child.

Permanent and Total Disability. A disability as defined under Title XVI of the Social Security Act or under applicable state laws. (1) For Adults 18 Years of Age or Older. (a) The condition of an individual, 18 years of age or older, who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that 1. can be expected to result in death; or 2. has lasted or can be expected to last for a continuous period of not less than 12 months. (b) For purposes of 130 CMR 501.001: Permanent and Total Disability, an individual 18 years of age or older is determined to be disabled only if their physical or mental