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19 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

519.009: MassHealth Limited

(A) Eligibility Requirements (1) MassHealth Limited is available to community residents 65 years of age and older who meet the financial and categorical requirements of MassHealth Standard coverage as described at 130 CMR 519.005(A) and (B) and who are (a) other noncitizens described in 130 CMR 518.003(D): Other Noncitizens; (b) qualified noncitizens barred as described in 130 CMR 518.003(A)(2): Qualified Noncitizens Barred; (c) nonqualified individuals lawfully present as described in 130 CMR 518.003(A)(3): Nonqualified Individuals Lawfully Present; or (d) nonqualified persons residing under color of law (nonqualified PRUCOLs) as described in 130 CMR 518.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs). (2) Community residents 65 years of age and older who are qualified noncitizens barred as described in 130 CMR 518.003(A)(2): Qualified Noncitizens Barred, nonqualified individuals lawfully present as described in 130 CMR 518.003(A)(3): Nonqualified Individuals Lawfully Present, and nonqualified PRUCOLs as described in 130 CMR 518.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs) may also be eligible for MassHealth Family Assistance if they meet the categorical and financial requirements of 130 CMR 519.013. (3) Persons eligible for MassHealth Limited coverage are eligible for medical benefits described at 130 CMR 450.105(F): MassHealth Limited.

(B) Use of Potential Benefits. All individuals who meet the requirements of 130 CMR 519.009 must use potential health-insurance benefits in accordance with 130 CMR 517.008: Potential Sources of Healthcare and must enroll in health insurance, including Medicare, if available at no greater cost to the applicant or member than they would pay without access to health insurance. Members must access those other health-insurance benefits and must show both their private health-insurance card and their MassHealth card to providers at the time services are provided.

(C) Coverage Date. The start date of medical coverage is established in accordance with 130 CMR 519.009(C)(1) through (3). (1) If covered medical services were received during the period for which coverage was requested, and the individual would have been eligible at the time services were provided, the start date of coverage is determined upon receipt of the completed application and may be retroactive to the first day of the third calendar month before the month of application. An application is considered complete if it complies with 130 CMR 516.001(C). (2) If covered medical services were not received during such period, or the individual would not have been eligible at the time services were provided, the start date of coverage is determined upon receipt of the completed application, and coverage begins on the first day of the month in which the application was received. An application is considered complete if it complies with 130 CMR 516.001(C).