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7 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 517: MASSHEALTH: UNIVERSAL ELIGIBILITY REQUIREMENTS

517.008: Potential Sources of Healthcare

The MassHealth agency is payer of last resort and pays for healthcare and related services only when no other source of payment is available, except as otherwise required by federal law.

(A) Health Insurance. Every applicant and member must obtain and maintain health insurance available at no cost to the member, including, but not limited to, Medicare and insurance purchased by the MassHealth agency in accordance with 130 CMR 506.012: Premium Assistance Payments. Failure to do so may result in loss of eligibility.

(B) Use of Benefits. The MassHealth agency does not pay for any healthcare and related services that are available (1) through the member’s health insurance, if any; or (2) at no cost to the member, including, but not limited to, any such services that are available through any agency of the local, state, or federal government or any entity legally obligated to provide those services.

517.009: Assignment of Rights to Medical Support and Third-party Payments

(A) Every legally able applicant or member must assign to the MassHealth agency their rights to medical support and third-party payments for medical benefits provided under MassHealth as well as the rights of applicants or members for whom they can legally assign medical support and third-party payments.

(B) The applicant or member must fully cooperate with the MassHealth agency in (1) establishing paternity; (2) obtaining any medical support and payments; and (3) identifying and providing information to assist the MassHealth agency in pursuing third parties, including a noncustodial parent, who may be legally obligated to pay for care and services for the applicant or member, or person on whose behalf benefits are requested, unless the applicant or member has grounds to waive cooperation as described in 130 CMR 517.010 or 505.002(D): Eligibility Requirements for People Who Are Pregnant.

(C)(1) The MassHealth agency will deny eligibility for any applicant who does not attest to a willingness to cooperate and will terminate eligibility for any member who refuses to cooperate, unless the applicant or member demonstrates good cause, as described in 130 CMR 517.010, or is a pregnant person who meets the requirements of 130 CMR 505.002(D): Eligibility Requirements for People Who Are Pregnant. (2) The MassHealth agency will not deny or terminate eligibility of any applicant or member who cannot legally assign their own rights, including, but not limited to, a minor child, and who would otherwise be eligible but for the refusal by a person legally able to assign the child’s rights to assign the child’s rights or to cooperate as required in 130 CMR 517.009.