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8 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 515.000: MASSHEALTH: GENERAL POLICIES

Permanent and Total Disability. A disability as defined under Title XVI of the Social Security Act or under applicable state laws. (1) For Adults and 18-year-olds (a) The condition of an individual 18 years of age or older who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that 1. can be expected to result in death; or 2. has lasted or can be expected to last for a continuous period of not less than 12 months. (b) For purposes of 130 CMR 515.001: Permanent and Total Disability, an individual 18 years of age or older is determined to be disabled only if their physical or mental impairments are of such severity that the individual is not only unable to do their previous work, but cannot, considering age, education, and work experience, engage in any other kind of substantial gainful work that exists in the national economy, regardless of whether such work exists in the immediate area in which the individual lives, whether a specific job vacancy exists, or whether the individual would be hired if they applied for work. "Work that exists in the national economy" means work that exists in significant numbers, either in the region where such an individual lives or in several regions of the country. (2) For Children Younger than 18 Years Old. The condition of an individual younger than 18 years old who has any medically determinable physical or mental impairment, or combination of impairments, that causes marked and severe functional limitations, as defined in Title XVI of the Social Security Act, and can be expected to cause death or can be expected to last for a continuous period of not less than 12 months. Disability for children eligible for CommonHealth under 130 CMR 519.012(B): Certain Disabled Institutionalized and Immigrant Children Who Are Noncitizens is determined in accordance with the definition for permanent and total disability for children younger than 18 years old in 130 CMR 501.001: Definition of Terms.

Personal Needs Allowance (PNA). The designated portion of monthly income that a person in long- term care is allowed to retain for personal expenses. In some instances, the MassHealth agency pays all or a portion of the PNA to the member. The PNA must not be used for payment of any item included in the daily rate at the long-term-care facility.

Personal Needs Allowance (PNA) Account. An account administered by a long-term-care facility on behalf of a member. Regulations regarding the administration of PNA accounts are contained in 130 CMR 456.601 through 456.615.

Pooled Trust. A trust that meets all the following criteria as determined by the MassHealth agency. (1) The trust was created by a nonprofit organization. (2) A separate account is maintained for each beneficiary of the trust, but the assets of the trust are pooled for investment and management purposes. (3) The account in a pooled trust was created for the sole benefit of the individual by the individual, the individual's parents or grandparents, or a legal guardian or court acting on behalf of the individual. (4) The trust provides that the Commonwealth of Massachusetts will receive amounts remaining in the account upon the death of the individual up to the amount paid by the MassHealth agency for services to the individual. The trust may retain reasonable and appropriate amounts as determined by the MassHealth agency. (5) The individual was disabled at the time their account in the pool was created.