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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

(E) Disabled Children Younger than 18 Years Old. Disabled children younger than 18 years old must meet the following requirements: (1) be permanently and totally disabled, as defined in 130 CMR 501.001: Definition of Terms; (2) be ineligible for MassHealth Standard; and (3) be a citizen as described at 130 CMR 504.002: U.S. Citizens, lawfully present immigrant, or a nonqualified PRUCOL, as described in 130 CMR 504.003: Immigrants.

(F) Determination of Disability. Disability is established by (1) certification of legal blindness by the Massachusetts Commission for the Blind (MCB); (2) a determination of disability by the SSA; or (3) a determination of disability by the Disability Evaluation Services (DES).

(G) MassHealth CommonHealth Premium. Disabled adults, disabled young adults, and disabled children who meet the requirements of 130 CMR 505.004 may be assessed a premium in accordance with the premium schedule provided in 130 CMR 506.011(B)(2).

(H) Use of Potential Health Insurance Benefits. Applicants and members must use potential health insurance benefits, in accordance with 130 CMR 503.007: Potential Sources of Health care, and must enroll in health insurance, including Medicare, if available at no greater cost to the applicant or member than they would pay without access to health insurance, or if purchased by the MassHealth agency in accordance with 130 CMR 505.002(O) and 130 CMR 506.012: Premium Assistance Payments. Members must access those other health insurance benefits and must show their private health insurance card and their MassHealth card to providers at the time services are provided.

(I) Access to Employer-sponsored Health Insurance and Premium-assistance Investigations for Individuals Who Are Eligible for MassHealth CommonHealth. (1) The MassHealth agency may perform an investigation to determine if individuals receiving MassHealth CommonHealth (a) have health insurance that MassHealth may help pay for; or (b) have access to employer-sponsored health insurance in which MassHealth wants the individual to enroll and for which MassHealth will help pay. (2) The individual receives MassHealth CommonHealth while the MassHealth agency investigates the insurance. (a) Investigations for Individuals Who Are Enrolled in Health Insurance. 1. If the MassHealth agency determines that the health insurance that the individual is enrolled in meets the criteria at 130 CMR 506.012: Premium Assistance Payments, the individual is notified in writing that MassHealth will provide MassHealth CommonHealth Premium Assistance as described at 130 CMR 506.012: Premium Assistance Payments. 2. If the MassHealth agency determines that the health insurance that the individual is enrolled in does not meet the criteria at 130 CMR 506.012: Premium Assistance