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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

(c) If satisfactory documentary evidence of citizenship and identity or immigration status is received before the end of the reasonable-opportunity period, retroactive coverage is provided in accordance with 130 CMR 502.006(A)(2).

(G) Reasonable Opportunity Extension. Applicants or members who have made a good faith effort to resolve inconsistencies or obtain verification of immigration status may receive a 90-day extension. Requests for a reasonable opportunity extension must be made before the expiration of the verification time period.

(H) Hospital-determined Presumptive Eligibility. (1) Presumptive Eligibility Determinations. A qualified hospital may make presumptive eligibility determinations for its patients in accordance with 130 CMR 450.110: Hospital- determined Presumptive Eligibility. Presumptive eligibility will be determined based on attested information. The MassHealth agency will use estimated gross household income rather than MassHealth MAGI to assess whether the financial requirements described below have been met. The qualified hospital may determine presumptive eligibility for the following: (a) MassHealth Standard if the individual appears to meet categorical and financial requirements in 130 CMR 505.002: MassHealth Standard and the individual is 1. a child younger than one year old; 2. a child one through 18 years old; 3. a young adult 19 through 20 years old; 4. pregnant; 5. a parent or caretaker relative; 6. an individual with breast or cervical cancer; 7. an individual who is HIV positive; or 8. an independent foster care adolescent up to 26 years old; (b) MassHealth CarePlus if the individual appears to meet categorical and financial requirements in 130 CMR 505.008: MassHealth CarePlus and the individual is an adult 21 through 64 years old; (c) MassHealth Family Assistance if the individual appears to meet categorical and financial requirements in 130 CMR 505.005(C): Eligibility Requirements for Children and Young Adults Who Are Nonqualified PRUCOLs with Modified Adjusted Gross Income of the MassHealth MAGI Household at or below 150% of the Federal Poverty Level or 130 CMR 505.005(E): Eligibility Requirement for HIV-Positive Individuals Who Are Citizens or Qualified Noncitizens with Modified Adjusted Gross Income of the MassHealth MAGI Household Greater than 133 and Less than or Equal to 200% of the Federal Poverty Level and is 1. a child or a young adult who is a nonqualified PRUCOL as described in 130 CMR 504.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs); or 2. an individual who is HIV positive; or