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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

the MassHealth Disabled Adult household that is less than or equal to 133% of the FPL. 3. parents and caretakers who are 21 through 64 years old who are receiving EAEDC; and 4. adults 21 through 64 years old who are receiving EAEDC. (2) Nonqualified PRUCOLs eligible for MassHealth Limited in 130 CMR 505.006(B)(1)(b) and qualified noncitizens barred and nonqualified individuals lawfully present eligible for MassHealth Limited in 130 CMR 505.006(B)(1)(c) may also be eligible for MassHealth CommonHealth if they meet the categorical and financial requirements in 130 CMR 505.004 or MassHealth Family Assistance if they meet the categorical and financial requirements in 130 CMR 505.005. (3) Persons eligible for MassHealth Limited coverage are eligible for medical benefits as described in 130 CMR 450.105(F): MassHealth Limited. These individuals are eligible for medical benefits under MassHealth Limited only to the extent that such benefits are not covered by their health insurance.

(C) Use of Potential Health Insurance Benefits. All individuals who meet the requirements of 130 CMR 505.006 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. Members must access those other health insurance benefits and must show both their private health insurance card and their MassHealth card to providers at the time services are provided.

(D) Medical Coverage Date. (1) The medical coverage date for MassHealth Limited is described at 130 CMR 502.006: Coverage Dates, except as described at 130 CMR 505.006(D)(2). (2) Provisional eligibility is described in 130 CMR 502.003(E): Provisional Eligibility.

(E) Referral to Children’s Medical Security Plan. The MassHealth agency submits the names of children who are eligible for MassHealth Limited coverage to the Children’s Medical Security Plan.

505.007: Medicare Savings Program (MSP, also called Buy-in)

Medicare Savings Program coverage is available to Medicare beneficiaries in accordance with 130 CMR 519.010: Medicare Savings Program (MSP) – for Qualified Medicare Beneficiaries (QMBs) and 130 CMR 519.011: Medicare Savings Program (MSP) – Specified Low Income Medicare Beneficiaries (SLMBs) and Qualifying Individuals (QIs). MassHealth Standard members receive this benefit under 130 CMR 505.002(O). MassHealth CommonHealth members receive this benefit in accordance with 130 CMR 505.004(J).