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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

(a) Provisional eligibility is not available for adults 21 years of age or older who have not verified all income in their MAGI household, as described at 130 CMR 506.000: Health Care Reform: MassHealth: Financial Requirements, unless the individual is 1. pregnant and has attested MAGI income at or below 200% of the federal poverty level (FPL); 2. 21 through 64 years old and HIV-positive with attested MAGI income at or below 200% of the FPL; or 3. in active treatment for breast or cervical cancer and is younger than 65 years old with attested MAGI income at or below 250% of the FPL. (b) The MassHealth agency will not accept self-attestation of disability. Disability must be verified as described in 130 CMR 505.002(E)(1): Disabled Adults. Eligibility for applicants who apply for benefits based on disability will be determined as if they were not disabled until disability is verified as described in 130 CMR 505.002(E)(1): Disabled Adults. (c) A member’s coverage type will not be redetermined during the provisional eligibility period, except that members granted provisional eligibility who attest to pregnancy will be enrolled in MassHealth Standard.

(F) Reasonable Opportunity to Verify Citizenship and Identity or Immigration Status. The MassHealth agency provides applicants and members a reasonable opportunity period to provide satisfactory documentary evidence of citizenship and identity or immigration status if MassHealth’s electronic data matches are unable to verify the applicant’s citizenship or immigration status. (1) Time Standards. The reasonable period begins on, and extends 90 days from, the date on which an applicant or member receives a reasonable opportunity notice. (2) Coverage Start Date. (a) Coverage for individuals who are pregnant and children younger than 19 years old who receive a reasonable-opportunity period will begin as follows. 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 application 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 application 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). (b) Coverage for all other individuals who receive a reasonable-opportunity period begins on the first day of the month in which the application was received.