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13 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

(E) Home- and Community-based Services Waiver for Young Children with Autism (1) Clinical Requirements. The Home- and Community-based Services Waiver 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 at home or in the community provided they (a) have a confirmed diagnosis of an autism spectrum disorder (which includes autistic disorder, pervasive developmental disorder—not otherwise specified (PDD-NOS), Rhett’s syndrome, childhood disintegrative disorder, and Asperger’s syndrome); (b) would be institutionalized in an intermediate-care facility for people who are intellectually disabled unless they receive one or more of the services administered by the Department of Developmental Services under the Home- and Community-based Services Waiver authorized under § 1915(c) of the Social Security Act; and (c) are able to be safely served in the community. (2) Eligibility Requirements and Limitations (a) The applicant or member must be younger than nine years old. (b) The child must be eligible for MassHealth Standard in accordance with 130 CMR 505.002(B)(1): Children Younger Than One Year Old and (2): Children One through 18 Years Old. (c) Assets are not considered in the eligibility determination. (d) The number of children who can be enrolled in this waiver may be limited in a manner determined by the MassHealth agency or its agent.

(F) Home- and Community-based Services Waiver for Persons with Traumatic Brain Injury (1) Clinical and Age Requirements. The Home- and Community-based Services Waiver for Persons with Traumatic Brain Injury allows an applicant or member who is certified by the MassHealth agency or its agent to be in need of nursing facility services or chronic or rehabilitation hospital services to receive specified waiver services in the home or community if they (a) are 18 years of age or older and, if younger than 65 years old, are totally and permanently disabled in accordance with Title XVI standards; (b) have traumatic brain injury, as defined in Massachusetts Rehabilitation Commission (MRC) regulations at 107 CMR 12.02: Meaning of Terms in 107 CMR 12.00; (c) need one or more of the services administered by MRC under the Home- and Community-based Services Waiver authorized under § 1915(c) of the Social Security Act; and (d) are able to be safely served in the community. (2) Eligibility Requirements. In determining eligibility for MassHealth Standard and for 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 (a) meet the requirements of 130 CMR 519.007(F)(1); (b) have a countable income amount that is less than or equal to 300% of the FBR for an individual;