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23 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

519.013: MassHealth Family Assistance

(A) Eligibility Requirements. MassHealth Family Assistance is available to community residents 65 years of age and older who meet the following requirements: (1) 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; or 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), (a) with the countable-income amount, as defined in 130 CMR 520.009: Countable- income Amount, of the individual or married couple living together less than or equal to 100% of the federal poverty level (FPL); (b) with the countable assets of an individual $2,000 or less and those of a married couple living together $3,000 or less; and (c) without health insurance or access to health insurance; or (2) are nonqualified PRUCOLs, as described in 130 CMR 518.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs), (a) with modified adjusted gross income of the MassHealth MAGI household, as described in 130 CMR 506.000: Health Care Reform: MassHealth: Financial Requirements, between 100% and 300% of the FPL; and (b) without health insurance or access to health insurance.

(B) Financial Standards Not Met. Individuals described in 130 CMR 519.013(A)(1) whose income, assets, or both exceed the standards set forth in 130 CMR 519.013(A) may establish eligibility for MassHealth Family Assistance by reducing their assets in accordance with 130 CMR 520.004: Asset Reduction, meeting a deductible as described at 130 CMR 520.028 through 130 CMR 520.035, or by both.

(C) Benefits. Individuals eligible for MassHealth Family Assistance are eligible for medical benefits on a fee-for-service basis as defined in 130 CMR 515.001: Definition of Terms. These medical benefits are described in MassHealth regulations at 130 CMR 450.105(G): MassHealth Family Assistance.

(D) Coverage Date. The start date of medical coverage is established in accordance with 130 CMR 519.013(D)(1) through (3). MassHealth Family Assistance members are eligible for medical coverage under MassHealth Limited if otherwise eligible for MassHealth Limited as described in 130 CMR 519.009. (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).