Page 2
2 130 CMR: DIVISION OF MEDICAL ASSISTANCE
Trans. by E.L. 258 Rev. 02/13/26
130 CMR 519.000: MASSHEALTH: COVERAGE TYPES
519.001: Introduction
(A) Categorical Requirements and Financial Standards. 130 CMR 519.000 explains the categorical requirements and financial standards that must be met to qualify for a MassHealth coverage type. The rules of financial responsibility and the calculation of financial eligibility are detailed in 130 CMR 520.000: MassHealth: Financial Eligibility.
(B) MassHealth Coverage Types. The MassHealth coverage types available to individuals 65 years of age and older, institutionalized individuals, and those who would be institutionalized without community-based services are the following: (1) MassHealth Standard; (2) MassHealth Limited; (3) Medicare Savings Program (MSP) for Qualified Medicare Beneficiaries (QMBs) (Senior Buy-in); (4) MSP for Specified Low-income Medicare Beneficiaries (SLMBs) and Qualifying Individuals (QIs) (Buy-in); (5) MassHealth CommonHealth; and (6) MassHealth Family Assistance.
(C) Determining Eligibility. The MassHealth agency determines eligibility for the most comprehensive coverage available to the applicant, although the applicant has the right to choose to have eligibility determined only for MSP for QMBs or MSP for SLMB and QI coverage. If no choice is made by the applicant, the MassHealth agency determines eligibility for all available coverage types.
519.002: MassHealth Standard
(A) Overview (1) 130 CMR 519.002 through 130 CMR 519.007 contain the categorical requirements and asset and income standards for MassHealth Standard, which provides coverage for individuals aged 65 and older, institutionalized individuals, and those who would be institutionalized without community-based services. (2) Individuals eligible for MassHealth Standard are eligible for medical benefits on a fee- for-service basis as defined in 130 CMR 515.001: Definition of Terms. The medical benefits are described in 130 CMR 450.105(A): MassHealth Standard. (3) The start date of medical coverage for MassHealth Standard is established in accordance with 130 CMR 519.002(A)(3)(a) through (b).