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4 130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 256 Rev. 02/13/26

130 CMR 516.000: MASSHEALTH: THE ELIGIBILITY PROCESS

(A) Information Matches. The MassHealth agency initiates information matches with federal and state agencies and other informational services, as described at 130 CMR 516.004, when an application is received, in order to verify eligibility.

(B) Electronic Data Sources. If electronic data sources are unable to verify or are not reasonably compatible with the attested information, additional documentation will be required from the individual.

(C) Request for Information Notice. If additional documentation is required, including corroborative information as described at 130 CMR 516.001(B), a Request for Information Notice will be sent to the applicant, listing all requested verifications and the deadline for submission of the requested verifications.

(D) Time Standards. The following time standards apply to the verification of eligibility factors. (1) The applicant or member has 30 days from the receipt of the Request for Information Notice to provide all requested verifications. (2) If the applicant or member fails to provide verification of information within 30 days of receipt of the MassHealth agency’s request, MassHealth coverage is denied or terminated. (3) A new application is required if a reapplication is not received within 30 days of the date of denial.

(E) Reasonable Opportunity to Verify Citizenship and Identity or Immigration Status. The MassHealth agency provides applicants and members with a reasonable opportunity period to provide satisfactory documentary evidence of citizenship and identity or immigration status if the MassHealth agency’s electronic data matches are unable to verify the applicant’s citizenship or immigration status. (1) Time Standards. The reasonable opportunity period begins on, and extends 90 days from, the date on which an applicant or member receives a reasonable opportunity notice. (2) Coverage Start Date. (a) Coverage for individuals who receive a reasonable opportunity period begins on the date the Request for Information Notice is sent. (b) If satisfactory documentary evidence of citizenship and identity or immigration status is received before the end of the reasonable opportunity period, retroactive coverage is provided for the verified coverage type in accordance with 130 CMR 516.006.

(F) Reasonable Opportunity Extension. Applicants or members who have made a good-faith effort to resolve inconsistencies or obtain verification of immigration status may receive a 90-day extension. Requests for a reasonable opportunity extension must be made before the expiration of the verification time period.