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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

(d) MassHealth CommonHealth if the individual appears to meet categorical and financial requirements in 130 CMR 505.004: MassHealth CommonHealth for disabled children younger than 20 years old. (2) Coverage Start Date. Benefits provided through the hospital presumptive eligibility process will begin on the date that the hospital determines presumptive eligibility and will continue until (a) the end of the month following the month in which the hospital determined presumptive eligibility, if the individual has not submitted a complete application as described in 130 CMR 502.001 by that date; or (b) an eligibility determination is made based upon the individual’s submission of a complete application as described in 130 CMR 502.001, if the complete application was submitted before the end of the month following the month of the hospital-presumptive eligibility determination. (3) Premium Assessment. Individuals who are determined eligible through hospital- determined presumptive eligibility will not be assessed a premium. Premium assistance is not awarded during the presumptive eligibility period. (4) Continued Eligibility. The individual must submit a complete application as described in 130 CMR 502.001 to determine continued eligibility for MassHealth.

(I) Verification Exceptions for Special Circumstances. Except with respect to the verification of citizenship and immigration status, the MassHealth agency will permit, on a case-by-case basis, self-attestation of individuals for all eligibility criteria when documentation does not exist at the time of application or renewal, or is not reasonably available, such as in the case of individuals who are homeless or have experienced domestic violence or a natural disaster.

502.004: Matching Information

The MassHealth agency may initiate information matches with other agencies and information sources when an application is received, at annual renewal, and periodically, to update or verify eligibility. These agencies and information sources may include, but are not limited to, the following: the Federal Data Services Hub, the Department of Unemployment Assistance, the Department of Public Health's Bureau of Vital Statistics, the Department of Industrial Accidents, the Department of Veterans' Services, the Department of Revenue, the Bureau of Special Investigations, the Social Security Administration, the Systematic Alien Verification for Entitlements, the Department of Transitional Assistance, and health insurance carriers.

502.005: Time Standards for an Eligibility Determination

(A) For applicants who do not apply based on a disability, the MassHealth agency makes an eligibility determination (1) within 60 days from the date of receipt of the complete application if the applicant is