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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

confirmed through electronic data matches if available. If verification through electronic data match is unsuccessful, the MassHealth agency will request required verifications as described in 130 CMR 502.003 and the individual continues to receive benefits pending verification. 2. If the renewal application is not completed within 45 days, the MassHealth agency will a. use information received from electronic sources, if available, and redetermine eligibility; or b. if information is not available from electronic sources, terminate MassHealth coverage as described at 130 CMR 502.006(B). 3. If the individual submits the prepopulated renewal application within 90 days of the termination date, as described in 130 CMR 502.007(C)(2)(b)2., and is determined eligible for a MassHealth benefit, the date of coverage for MassHealth is determined in accordance with 130 CMR 502.006(A). The begin date of MassHealth coverage may be retroactive to the date of the termination if the individual requests retroactive coverage and has incurred covered medical services since the date of the termination. 4. If the prepopulated renewal application is returned, but the required verifications are not submitted with the form, a second 90-day period starts on the date that the prepopulated form is returned. 5. If the prepopulated renewal application is not submitted within 90 days of the previous termination date, a new application is required. (c) If the member's coverage type changes, the start date for the new coverage type is determined as follows. 1. If the member's coverage type changes, the start date for the new coverage type is effective as described in 130 CMR 502.006(A). 2. Premium assistance payments begin in the month of the MassHealth agency's eligibility determination or in the month the insurance begins, whichever is later in accordance with 130 CMR 506.012(F)(1)(d). (3) Periodic Data Matches. The MassHealth agency matches files of MassHealth members with other agencies and information sources as described in 130 CMR 502.004 to update or verify eligibility. (a) If the electronic data match indicates a change in circumstances that would result in potential reduction or termination of benefits, the MassHealth agency will notify the member of the information that was received through the data match and require the member to respond within 30 days of the date of the notice. 1. If the member responds within 30 days and confirms the data is correct, eligibility will be determined using the confirmed data from the electronic data match. 2. If the member responds within 30 days and provides new information, eligibility will be determined using the information provided by the member. Additional verification from the member will be required. 3. If the member does not respond within 30 days, eligibility will be determined