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5 130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 257 Rev. 02/13/26

130 CMR 517: MASSHEALTH: UNIVERSAL ELIGIBILITY REQUIREMENTS

517.005: Persons Institutionalized for Mental Disease

(A) Individuals younger than 18 years old and those 65 years of age or older who are patients in a public or private institution for mental disease may be eligible for MassHealth.

(B) Individuals who reach 18 years old while they are patients in an institution for mental disease may be eligible for MassHealth until they reach age 22 years old, provided they are disabled in accordance with Title XVI requirements.

(C) Individuals between 18 and 65 years old who are patients in public or private institutions for mental disease are not eligible for MassHealth, except as provided in 130 CMR 517.005(B). Such individuals may establish eligibility for MassHealth when entering an acute hospital from a public or private institution for mental disease if otherwise categorically and financially eligible.

517.006: Social Security Number (SSN)

(A) Requirements (1) Condition of Eligibility. As a condition of eligibility for MassHealth, all persons applying in the household must furnish an SSN or proof of application for an SSN, except as provided in 130 CMR 517.006(A)(1). The applicant is notified of the obligation to apply for an SSN for any person applying in the household. The MassHealth agency does not require an SSN or proof of application for an SSN for any applicant who (a) attests to a religious exemption as described in federal law; (b) is only eligible for a nonwork SSN; or (c) is not eligible to receive an SSN. (2) Electronic Data Match. The MassHealth agency verifies each SSN by an electronic data match with the Social Security Administration (SSA). (3) Reasonable Opportunity to Verify a Social Security Number (SSN). If the applicant has provided an SSN, the MassHealth agency matches with the SSA to verify the SSN. If the SSA is unable to verify the SSN, the individual is required to verify their SSN. (a) The MassHealth agency provides applicants and members with a reasonable opportunity period to provide an SSN if the SSA is unable to verify the SSN or the individual has not provided the SSN. (b) The reasonable opportunity period begins on, and will extend 90 days from, the date on which an applicant or member receives a Request for Information. (c) While the verification of SSN is pending, the individual will receive benefits if there are no other verifications outstanding.

(B) Right to Know Uses of Social Security Numbers (SSNs). All household members are given a written notice of the following: (1) the reason the SSNs are requested; (2) the computer matching of SSNs with SSNs in other personal data files within (a) the MassHealth agency;