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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 254 Rev. February 13, 2026

130 CMR 505.000: HEALTH CARE REFORM: MASSHEALTH: COVERAGE TYPES

individual is younger than 21 years old or is pregnant. 2. If the MassHealth agency determines the individual does not have access to employer-sponsored health insurance, the individual is eligible for MassHealth Standard Direct Coverage. 3. Individuals described at 130 CMR 505.002(F) and (G) will not undergo an investigation.

(O) Medicare Premium Payment. (1) The MassHealth agency, in accordance with the Medicare Savings Program as described at 130 CMR 519.010: Medicare Savings Program (MSP) – Qualified Medicare Beneficiaries (QMBs) and 519.011: Medicare Savings Program (MSP)– Specified Low Income Medicare Beneficiaries (SLMBs) and Qualifying Individuals (QIs), or in accordance with 130 CMR 519.002(E), pays the following for members who meet the requirements of 130 CMR 505.002(C) and (E): (a) the cost of the monthly Medicare Part B premiums; (b) where applicable, the cost of the hospital insurance under Medicare Part A for members who are entitled to Medicare Part A; and (c) where applicable, for the deductibles and coinsurance under Medicare Parts A and B. (2) The coverage begins in accordance with 130 CMR 519.010: Medicare Savings Program (MSP) – Qualified Medicare Beneficiaries (QMBs) and 519.011: Medicare Savings Program (MSP)– Specified Low Income Medicare Beneficiaries (SLMBs) and Qualifying Individuals (QIs).

(P) Medical Coverage Date. (1) The medical coverage date for MassHealth Standard is described at 130 CMR 502.006: Coverage Dates, except as described at 130 CMR 505.002(P)(2). (2) Provisional eligibility is described in 130 CMR 502.003(E): Provisional Eligibility.

(Q) Continuous Eligibility. (1) Continuous Eligibility, as defined in 501.001: Continuous Eligibility (CE), will be granted to children under age 19. Children in a CE period will receive 12 months of continuous coverage upon completion of initial application or annual renewal period. (2) Coverage will continue without downgrading or ending except for reasons found at 130 CMR 501.001: Definition of Terms.

(130 CMR 505.003 Reserved)