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15 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

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) Enrollment Limits. Enrollment in the Residential Habilitation Waiver is subject to a limit on the total number of waiver participants. The number of participants who can be enrolled in this waiver may be limited in a manner determined by the MassHealth agency. (d) Waiver Services. Eligible members who are enrolled as waiver participants in the Residential Habilitation Waiver are eligible for the waiver services described in 130 CMR 630.405(A): Acquired Brain Injury with Residential Rehabilitation (ABI-RH) Waiver. (2) Non-residential Habilitation Waiver for Persons with Acquired Brain Injury (a) Clinical and Age Requirements. The Non-residential Habilitation Waiver for Persons with acquired brain injury, as authorized under § 1915(c) of the Social Security Act, 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 disease or rehabilitation hospital services to receive specified waiver services, other than residential support services, in the home or community if they meet all of the following criteria: 1. are 22 years of age or older and, if younger than 65 years old, are totally and permanently disabled in accordance with Title XVI standards; 2. acquired, after reaching 22 years old, a brain injury including, without limitation, brain injuries caused by external force, but not including Alzheimer’s disease and similar neurodegenerative diseases, the primary manifestation of which is dementia; 3. are an inpatient in a nursing facility or chronic disease or rehabilitation hospital with a continuous length of stay of 90 or more days at the time of application for the waiver; 4. need one or more of the services under the Non-residential Habilitation Waiver; and 5. are able to be safely served in the community within the terms of the Non- residential Habilitation Waiver. (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 1. meet the requirements of 130 CMR 519.007(G)(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