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4 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

(2) Medicare Part A premiums for adult members of MassHealth Standard who are entitled to Medicare Part A with a countable income that is less than or equal to 190% of the FPL; and (3) the deductibles and coinsurance under Medicare Parts A and B for members with a countable income that is less than or equal to 190% of the FPL.

519.003: Pickle Amendment Cases

(A) Eligibility Requirements. Under the Pickle Amendment, former Supplemental Security Income (SSI) recipients whose income exceeds 100% of the federal poverty level are eligible for MassHealth Standard provided they (1) or their spouse or both are receiving Retirement, Survivors, and Disability Insurance (RSDI) benefits; (2) were eligible for and received SSI benefits after April 1977; (3) would be currently eligible for SSI, in accordance with SSI payment standards at 130 CMR 519.003(B), if the incremental amount of RSDI cost-of-living increases paid to them since the last month subsequent to April 1977 for which they were both eligible for and receiving SSI and entitled to (but not necessarily receiving) RSDI were deducted from the current amount of RSDI benefits. Cost-of-living increases referred to in 130 CMR 519.003 include increases received by the applicant or member or by the spouse. The spouse need not be otherwise eligible for SSI; and (4) have countable assets that are $2,000 or less for an individual and $3,000 or less for a married couple.

(B) SSI Payment Standards. The RSDI amount, as described in 130 CMR 519.003(A)(3), and any other countable-income amount, as defined in 130 CMR 520.009: Countable-income Amount, of the individual or couple is compared to the SSI payment standards to determine Pickle eligibility. Each calendar year, the SSI payment standards shall be made available on MassHealth’s website.

(C) Financial Standards Not Met. Individuals whose income, assets, or both exceed the standards in 130 CMR 519.003 may establish eligibility by reducing assets in accordance with 130 CMR 520.004: Asset Reduction, meeting a deductible as described in 130 CMR 520.028 through 520.035, or both.

519.004: Disabled Adult Children

(A) Eligibility Requirements. Individuals who lose eligibility for Supplemental Security Income (SSI) benefits may retain eligibility for MassHealth Standard provided that they (1) are 18 years of age or older; (2) became blind or disabled before reaching 22 years old; (3) receive or received SSI based on their blindness or disability;