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8 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 517: MASSHEALTH: UNIVERSAL ELIGIBILITY REQUIREMENTS

517.010: Waiver of Cooperation for Good Cause

(A) Good cause is established if (1) with respect to the obligation to establish paternity of a child born out of wedlock, to obtain medical-care support and payments, or to identify or provide information to assist the MassHealth agency in pursuing a liable third party for a child for whom the applicant or member can legally assign rights, the MassHealth agency finds that cooperation is against the best interest of the child; or (2) with respect to the obligation to cooperate in all cases not covered by 130 CMR 517.010(A)(1), the MassHealth agency finds that cooperation is not in the best interest of the applicant or member or the person for whom the benefit is being requested or furnished because it is anticipated that cooperation will result in reprisal against, and cause serious physical or emotional harm to, the applicant or member or another person.

(B) Good cause for noncooperation includes, but is not limited to, the following circumstances: (1) the child was conceived as a result of incest or forcible rape; (2) legal proceedings for adoption are pending before a court; (3) a public agency or licensed facility is assisting in resolving the issue of adoption and discussions have not lasted longer than three months; or (4) cooperation would result in serious physical or emotional harm to the child, the relative with whom the child resides, or to the applicant or member.

517.011: Assignment of Rights to Spousal Support

An institutionalized spouse whose community spouse refuses to cooperate or whose whereabouts is unknown will not be ineligible due to

(A) assets determined to be available for the cost of care in accordance with 130 CMR 520.016(B): Treatment of a Married Couple’s Assets When One Spouse Is Institutionalized; or

(B) their inability to provide information concerning the assets of the community spouse when one of the following conditions is met: (1) the institutionalized spouse assigns to the MassHealth agency any rights to support from the community spouse; (2) the institutionalized spouse lacks the ability to assign rights to spousal support due to physical or mental impairment as verified by the written statement of a competent medical authority; or (3) the MassHealth agency determines that the denial of eligibility, due to the lack of information concerning the assets of the community spouse, would otherwise result in undue hardship.