Page 5

5

130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 253 Rev. 02/13/2026

130 CMR 503.000: HEALTH CARE REFORM: MASSHEALTH: UNIVERSAL ELIGIBILITY REQUIREMENTS

third-party payments.

(B) The applicant or member must fully cooperate with the MassHealth agency in (1) establishing paternity; (2) obtaining any medical support and payments; and (3) identifying and providing information to assist the MassHealth agency in pursuing third parties, including a noncustodial parent, who may be legally obligated to pay for care and services for the applicant or member, or person on whose behalf benefits are requested, unless the applicant or member has grounds to waive cooperation as described in 130 CMR 503.005 or 505.002 (D): Eligibility Requirements for People Who Are Pregnant.

(C) (1) The MassHealth agency will deny eligibility for any applicant who does not attest to a willingness to cooperate and will terminate eligibility for any member who refuses to cooperate, unless the applicant or member demonstrates good cause, as described in 130 CMR 503.005, or is a pregnant person who meets the requirements of 130 CMR 505.002(D): Eligibility Requirements for People Who Are Pregnant. (2) The MassHealth agency will not deny or terminate eligibility of any applicant or member who cannot legally assign their own rights, including, but not limited to, a minor child, and who would otherwise be eligible but for the refusal, by a person legally able to assign the child’s rights, or to cooperate as required in 130 CMR 503.004.

503.005: Waiver of Cooperation for Good Cause

(A) Good cause is established if (1) the MassHealth agency finds that cooperation is against the best interest of the child with respect to the obligation to establish paternity of a child born out of wedlock, to obtain medical-care support and payments, or to identify or provide information to assist the MassHealth agency in pursuing a liable third party for a child for whom the applicant or member can legally assign rights; or (2) the MassHealth agency finds that cooperation is not in the best interest of the applicant or member or the person for whom the benefit is being requested or furnished because it is anticipated that cooperation will result in reprisal against, and cause serious physical or emotional harm to the applicant or member or another person with respect to the obligation to cooperate in all cases not covered by 130 CMR 503.005(A)(1).

(B) Good cause for noncooperation includes, but is not limited to, the following circumstances: (1) the child was conceived because of incest or forcible rape; (2) legal proceedings for adoption are pending before a court; (3) a public agency or licensed facility is assisting in resolving the issue of adoption and discussions have not lasted longer than three months; or (4) cooperation would result in serious physical or emotional harm to the child, the relative with whom the child resides, or to the applicant or member.