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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

eligible for MassHealth Family Assistance. (7) Persons eligible for MassHealth Family Assistance must obtain and maintain all available health insurance as described in 130 CMR 503.007: Potential Sources of Health Care.

(B) Eligibility Requirements for Children with Modified Adjusted Gross Income of the MassHealth MAGI Household Greater than 150% and Less than or Equal to 300% of the Federal Poverty Level (FPL). Children younger than 19 years old are eligible for MassHealth Family Assistance coverage described in 130 CMR 505.005(B) if they meet the following criteria. (1) Eligibility Requirements. A child is eligible if (a) the child is younger than 19 years old; (b) the child’s modified adjusted gross income of the MassHealth MAGI household is greater than 150 and less than or equal to 300% of the FPL; (c) the child is ineligible for MassHealth Standard or CommonHealth; (d) the child is a citizen as defined in 130 CMR 504.002: U.S. Citizens or a lawfully present immigrant as defined in 130 CMR 504.003(A), or a nonqualified PRUCOL, as defined in 130 CMR 504.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs); (e) the child complies with 130 CMR 505.005(B)(2) and meets one of the following criteria: 1. the child is uninsured; or 2. the child has health insurance that meets the criteria at 130 CMR 506.012: Premium Assistance Payments. (2) Access to Employer-sponsored Insurance and Premium Assistance Investigations for Individuals Who Are Eligible for MassHealth Family Assistance. The MassHealth agency may perform an investigation to determine if individuals potentially eligible for MassHealth Family Assistance (a) have health insurance that MassHealth can help pay for; or (b) have access to employer-sponsored insurance in which MassHealth wants the individual to enroll and for which MassHealth will help pay. 1. Investigations for Individuals Who Are Enrolled in Health Insurance. a. If the MassHealth agency determines that the health insurance 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 Family Assistance Premium Assistance Payments as described at 130 CMR 450.105(G)(1): Premium Assistance and 130 CMR 506.012: Premium Assistance Payments. b. If the MassHealth agency determines that the health insurance the individual is enrolled in does not meet the criteria at 130 CMR 506.012, the individual continues to be eligible for MassHealth Family Assistance. 2. Investigations for Individuals Who Have Potential Access to Employer-sponsored Health Insurance (ESI). a. If the MassHealth agency determines the individual has access to employer- sponsored health insurance, the employer is contributing at least 50% of the