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12 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 515.000: MASSHEALTH: GENERAL POLICIES

(B) The MassHealth agency offers the following types of coverage: Standard, Family Assistance, Limited, Senior Buy-in, and Buy-in. The type of coverage for which a person is eligible is based on the person's and the spouse's income and assets, as described in 130 CMR 519.000: MassHealth: Coverage Types and 130 CMR 520.000: MassHealth: Financial Eligibility, and immigration status, as described in 130 CMR 518.000: MassHealth: Citizenship and Immigration.

(C) The MassHealth agency may limit the number of people who can be enrolled in Family Assistance. When the MassHealth agency imposes such a limit, no new applicants 65 years of age or older who are subject to these limitations will be added to Family Assistance, and current Family Assistance members who have lost eligibility for more than 30 days for any reason will not be allowed to reenroll until the MassHealth agency reopens enrollment for adults. (1) Applicants who cannot be enrolled under Family Assistance pursuant to 130 CMR 515.003(C) will be placed on a waiting list when their eligibility has been determined. When the MassHealth agency is able to open enrollment for adult applicants, the applications will be processed in the order they were placed on the waiting list. (2) Medical coverage for Family Assistance for persons enrolled from a waiting list will begin on the date that the application or new determination is processed from the waiting list.

515.004: Administration of MassHealth

(A) MassHealth. The MassHealth agency formulates requirements and determines eligibility for all MassHealth coverage types.

(B) Other Agencies (1) Department of Transitional Assistance (DTA). (a) DTA administers the Transitional Aid to Families with Dependent Children (TAFDC) Program. Persons who meet the requirements of § 1931 of Title XIX (42 U.S.C. § 1396u-1) are automatically eligible for Standard coverage. (b) DTA also administers the Emergency Aid to the Elderly, Disabled and Children (EAEDC) Program. MassHealth provides coverage to those persons receiving EAEDC cash assistance as follows: 1. MassHealth Standard: children younger than 19 years old; young adults 19 and 20 years old who are citizens, qualified noncitizens, qualified noncitizens barred, or nonqualified individuals lawfully present; parents and caretakers who are citizens or qualified noncitizens; people 65 years of age or older who are citizens or qualified noncitizens; and adults 21 through 64 years old who are citizens or qualified noncitizens; 2. MassHealth CarePlus: adults 21 through 64 years of age who are citizens or qualified noncitizens; and 3. MassHealth Family Assistance: children younger than 19 years old; young adults 19 and 20 years of age who are nonqualified persons living under color of law (PRUCOLs); parents and caretakers who are qualified noncitizens barred; nonqualified individual lawfully present; nonqualified PRUCOLs; adults 21 through 64 years of age; and elders 65 years of age or older who are qualified noncitizens barred, nonqualified individual lawfully present, or nonqualified PRUCOLs, including PRUCOLs receiving EAEDC.