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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) Eligibility Requirement for HIV-positive Individuals Who Are Citizens or Qualified Noncitizens with Modified Adjusted Gross Income of the MassHealth MAGI Household Greater than 133 and Less than or Equal to 200% of the Federal Poverty Level (FPL). Individuals who are HIV positive are eligible for MassHealth Family Assistance coverage described in 130 CMR 505.005(E) if they meet the following criteria. (1) The individual is eligible if (a) the individual is younger than 65 years old; (b) the individual is ineligible for MassHealth Standard or MassHealth CommonHealth; (c) the individual’s modified adjusted gross income of the MassHealth MAGI household is greater than 133 and less than or equal to 200% of the FPL; (d) the individual is a citizen as defined in 130 CMR 504.002: U.S. Citizens or qualified noncitizen, as defined in 130 CMR 504.003(A)(1): Qualified Noncitizens; and (e) the individual has verified their HIV-positive status by providing a letter from a doctor, qualifying health clinic, laboratory, or AIDS service provider or organization. The letter must indicate the individual’s name and their HIV-positive status. (2) Health Insurance Investigation. MassHealth may perform an investigation to determine if individuals receiving MassHealth Family Assistance have health insurance that MassHealth may help pay for, as described at 130 CMR 506.012: Premium Assistance Payments. (a) If MassHealth 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 (2): Payment of Copayments, Coinsurance, and Deductibles for Certain Children Who Receive Premium Assistance and 130 CMR 506.012. (b) If MassHealth determines that the health insurance the individual is enrolled in does not meet the criteria at 130 CMR 506.012: Premium Assistance Payments, the individual is eligible for MassHealth Family Assistance Direct Coverage. (3) Unless otherwise indicated in 130 CMR 505.005(E)(2), individuals determined eligible for MassHealth Family Assistance as described in 130 CMR 505.005(E) will receive benefits as described in 130 CMR 450.105(G)(4): Managed Care Participation.

(F) Eligibility Requirement for Disabled Adults Who Are Qualified Noncitizens Barred, Nonqualified Individuals Lawfully Present, and Nonqualified PRUCOLs with Modified Adjusted Gross Income of the MassHealth Disabled Adult Household at or below 100% of the Federal Poverty Level. Individuals who are disabled adults are eligible for MassHealth Family Assistance coverage described in 130 CMR 505.005(F) if they meet the following criteria. (1) Eligibility Requirements. The individual is eligible if (a) the individual is totally and permanently disabled as defined in 130 CMR 501.001: Definition of Terms; (b) the individual is younger than 65 years old; (c) the individual is ineligible for MassHealth Standard or MassHealth CommonHealth; (d) the individual’s modified adjusted gross income of the MassHealth Disabled Adult household is at or below 100% of the FPL; and