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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

potentially eligible for MassHealth Family Assistance; or (2) within 45 days from the date of receipt of the complete application for all other nondisabled applicants.

(B) For applicants who apply based on a disability, the MassHealth agency makes an eligibility determination within 90 days from the date of receipt of the complete application.

(C) Households with one or more applicants 65 years of age or older who are not eligible for benefits under 130 CMR 501.000: Health Care Reform: MassHealth: General Policies through 130 CMR 508.000: MassHealth: Managed Care Requirements will be determined by the time standards described at 130 CMR 516.005: Time Standards for Eligibility Determination for the entire household.

(D) The time standards described in 130 CMR 502.005(A) through (C) may be extended by the amount of time used by the applicant to respond to requests for additional information needed to make the disability determination.

502.006: Coverage Dates

(A) Start Date of Coverage for Applicants. For individuals applying for coverage, the date of coverage for MassHealth is determined by130 CME 502.006(A)(2), except as specified in 130 CMR 502.003(E)(1), (F)(2), and (H)(2). (1) The start date of coverage for individuals approved for benefits under provisional eligibility is described at 130 CMR 502.003(E)(1). (2) The start date of coverage for individuals who have been determined eligible for a MassHealth benefit is described at 130 CMR 502.006(A)(2)(a) through (d), except individuals described at 130 CMR 502.006(C). (a) If covered medical services were received during the period for which coverage is requested, 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 or upon receipt of any requested verifications and may be retroactive to the first day of the third calendar month before the month of application, pursuant to 42 CFR 435.915 and except as specified in 130 CMR 502.006(C). (b) 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 or upon receipt of any requested verifications 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). (c) For individuals who fail to provide verifications of information within 90 days of the receipt of the MassHealth agency’s request and the MassHealth agency used information received from electronic data sources to determine eligibility, the start date of coverage is