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11 130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 258 Rev. 02/13/26

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

(2) Community Living Waiver (a) Clinical and Age Requirements. The Community Living Home- and Community- based Services Waiver for Persons with an Intellectual Disability allows an applicant or member who is certified by the MassHealth agency or its agent to be in need of inpatient care at an intermediate-care facility for people with intellectual disabilities to receive certain waiver services, other than residential habilitation, at home or in the community provided they 1. have an intellectual disability/developmental disability in accordance with Department of Developmental Services standards; 2. need one or more of the services administered by the Department of Developmental Services under the Community Living Home- and Community-based Services Waiver authorized under § 1915(c) of the Social Security Act; 3. need one or more of the services provided only under the Community Living Waiver; and 4. are 22 years of age or older and, if younger than 65 years of age, are totally and permanently disabled in accordance with Title XVI standards. (b) Eligibility Requirements. In determining eligibility for MassHealth Standard and for these waiver services, the MassHealth agency determines income eligibility based solely on the applicant’s or member’s income regardless of their marital status. The applicant or member must meet all of the following criteria: 1. meet the requirements of 130 CMR 519.007(D)(2)(a); 2. have countable income that is less than or equal to 300% of the FBR for an individual; 3. have countable assets of $2,000 or less for an individual and, for a married couple, if the initial waiver eligibility determination was on or after January 1, 2014, have assets that are less than or equal to the standards at 130 CMR 520.016(B): Treatment of a Married Couple’s Assets When One Spouse Is Institutionalized; and 4. not have transferred resources for less than fair market value, as described in 130 CMR 520.018: Transfer of Resources Regardless of Date of Transfer and 520.019: Transfer of Resources Occurring on or after August 11, 1993. (c) Financial Eligibility Standards Not Met. Individuals whose income, assets, or both exceed the standards set forth in 130 CMR 519.007(D)(2)(b) may establish eligibility for MassHealth Standard by reducing their assets in accordance with 130 CMR 520.004: Asset Reduction, by meeting a deductible as described in 130 CMR 520.028 through 520.035, or by both. (d) Enrollment Limits. Enrollment in the Community Living Home- and Community- based Services Waiver for Persons with an Intellectual Disability is subject to a limit on the total number of waiver participants. The number of participants who can be enrolled in the waiver may be limited in a manner determined by the MassHealth agency.