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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 260 Rev. 07/17/2026

130 CMR 508.000: MASSHEALTH: MANAGED CARE REQUIREMENTS

4 (11) a member who is eligible for emergency Medicaid benefits pursuant to Section 1903(v) of the Social Security Act; and (12) a member who is subject to a six-month deductible period under 130 CMR 520.028: Eligibility for a Deductible.

(C) One Care Plan. The following MassHealth members who are 21 through 64 years old at time of enrollment and who are enrolled in Medicare Parts A and B and are eligible for Medicare Part D are excluded from participation in a One Care Plan. (1) a member who has other health insurance, with the exception of Medicare, that meets the basic-benefit level as defined in 130 CMR 501.001: Basic-benefit Level (BBL); (2) a member who does not live in the designated service area of a One Care Plan; (3) a member in an ICF/ID; (4) a member who is not eligible for MassHealth Standard or CommonHealth; (5) a member who has presumptive eligibility; (6) a member who is enrolled in a home- and community-based services waiver; (7) a member who is eligible through the Emergency Aid to the Elderly, Disabled and Children (EAEDC) Program; (8) a member who is a refugee described at 130 CMR 522.002: Refugee Resettlement Program; (9) a member who is not eligible for benefits under Title XIX or XXI of the Social Security Act; (10) a member who is only eligible for benefits under Title XIX or XXI of the Social Security Act through Title XXI during the period from conception to the end of pregnancy; (11) a member who is eligible for emergency Medicaid benefits pursuant to Section 1903(v) of the Social Security Act; and (12) a member who is subject to a six-month deductible period under 130 CMR 520.028: Eligibility for a Deductible.

508.003 Enrollment with a MassHealth Managed Care Provider

(A) Member Selection. (1) In accordance with 130 CMR 508.004 through 508.006, members required or permitted to select a MassHealth managed care provider may select any MassHealth managed care provider from the MassHealth agency’s list of MassHealth managed care providers for the member’s coverage type in the member’s service area, if the provider is able to accept new members. (2) A member who seeks to enroll with a managed care provider outside of the member's service area must submit a request in writing to the MassHealth agency on forms provided by the MassHealth agency. The MassHealth agency may grant such a request if they determine that: (a) The out-of-area MassHealth managed care provider is in a service area contiguous to the member’s service area; or (b) The MassHealth agency determines either of the following: 1. the member seeks a specific provider who is in the network of the out-of-area MassHealth managed care provider, such requested provider is not in the network of a MassHealth managed care provider in the member’s service area, and the travel