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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 252 Rev. 02/13/2026

130 CMR 502.000: HEALTH CARE REFORM: MASSHEALTH: THE ELIGIBILITY PROCESS

determined upon the agency’s eligibility determination and coverage begins as described in 130 CMR 502.006(A)(c)1. and 2. 1. If covered medical services were received during such period, and the individual would have been eligible at the time services were provided, the start date of coverage is determined upon receipt of information received from electronic data sources and may be retroactive to the first day of the third calendar month before the month of application except as specified in 130 CMR 502.006(C). 2. If covered medical services were not received during such period, or the individual would not have been eligible at the time services were provided, the start date of coverage is determined upon receipt of the information received from electronic data sources and coverage begins on the first day of the month in which the application was received, except as specified in 130 CMR 502.006(C). (d) For individuals denied for failure to provide verification of requested information who then provide requested verifications or report changes after the denial, the start date of coverage is described in 130 CMR 502.006(A)(2)(d)1. and 2. 1. If covered medical services were received during such period, and the individual would have been eligible at the time services were provided, the start date of coverage is determined upon receipt of the verifications and may be retroactive to the first day of the third calendar month before the received date of the verifications, except as specified in 130 CMR 502.003(D)(2)(d) and 130 CMR 502.006(C). 2. If covered medical services were not received during such period, or the individual would not have been eligible at the time services were provided, the start date of coverage is determined upon receipt of the verifications and coverage begins on the first day of the month that the verifications were received, except as specified in 130 CMR 502.003(D)(2)(d) and 130 CMR 502.006.

(B) Coverage Dates for Existing Members Who Have a Change in Benefits. The date of coverage for existing members whose MassHealth coverage type changes due to a change in circumstances are described in 130 CMR 502.006(B)(1) through (4). (1) If covered medical services were received during such period, and the individual would have been eligible at the time services were provided, the start date of the new coverage may be retroactive to the first day of the third calendar month prior to (a). the receipt of the requested verifications; (b). the receipt date of the annual renewal; (c). the date of the eligibility determination for reported changes that do not result in request for verification; or (d). the date of the MassHealth agency’s eligibility determination due to information in the member’s case file. (2) If covered medical services were not received during such period, or the individual would not have been eligible at the time services were provided, the start date of the new coverage is the first day of the month of (a) the receipt of the requested verifications;