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11 130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 255 Rev. 02/13/26

130 CMR 515.000: MASSHEALTH: GENERAL POLICIES

Trust. A legal device satisfying the requirements of state law that places the legal control of property or funds with a trustee. It also includes, but is not limited to, any legal instrument, device, or arrangement that is similar to a trust, including transfers of property by a grantor to an individual or a legal entity with fiduciary obligations so that the property is held, managed, or administered for the benefit of the grantor or others. Such arrangements include, but are not limited to, escrow accounts, pension funds, and similar devices as managed by an individual or entity with fiduciary obligations.

Trustee. Any individual or legal entity that holds or manages a trust.

Uncompensated Value. The difference between the fair market value of the resource or interest in the resource at the time of transfer less any outstanding debts and the actual amount the individual received for the resource. The MassHealth agency uses the uncompensated value in the calculation of the period of ineligibility.

515.002: Introduction to MassHealth

(A) The MassHealth agency is responsible for the administration and delivery of healthcare services to low- and moderate-income individuals and couples.

(B) 130 CMR 515.000 through 522.000: MassHealth: Other Division Programs provide the MassHealth requirements for persons who are institutionalized, are 65 years of age or older, or would be institutionalized without community-based services in accordance with all applicable laws, including Title XIX of the Social Security Act.

(C) 130 CMR 501.000: MassHealth: General Policies through 508.000: Health Care Reform: MassHealth: Managed Care Requirements provide the MassHealth requirements for children, young adults, parents and caretaker relatives, adults, pregnant people, disabled persons, persons who are HIV positive, individuals with breast or cervical cancer, and certain other individuals or couples who are younger than 65 years old and not institutionalized. These requirements are prescribed in accordance with all applicable laws, including Title XIX and Title XXI of the Social Security Act and MassHealth’s 1115 Medicaid Research and Demonstration Waiver.

(D) The MassHealth agency will determine eligibility for low-income subsidies under Medicare Part D, as set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and as described at 20 CFR Part 418.

515.003: MassHealth Coverage Types

(A) The MassHealth agency provides access to healthcare by determining eligibility for the coverage type that provides the most comprehensive benefits for a person who may be eligible. Generally, members are provided with services on a fee-for-service basis as defined at 130 CMR 515.001.