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7 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

(A) The Kaileigh Mulligan Program. The Kaileigh Mulligan Program enables severely disabled children younger than 18 years old to remain at home. The income and assets of their parents are not considered in the determination of eligibility. (1) Eligibility Requirements. Children younger than 18 years old may establish eligibility for the Kaileigh Mulligan Program by meeting the following requirements. They must (a) 1. meet Title XVI disability standards in accordance with the definition of permanent and total disability for children younger than 18 years old in 130 CMR 515.001: Definition of Terms or have been receiving Supplemental Security Income (SSI) on August 22, 1996; and 2. continue to meet Title XVI disability standards that were in effect before August 22, 1996; (b) have $2,000 or less in countable assets; (c) 1. have a countable-income amount of $72.80 or less; or 2. if their countable income is greater than $72.80, meet a deductible in accordance with 130 CMR 520.028 through 520.035; and (d) require a level of care equivalent to that provided in a hospital or nursing facility in accordance with 130 CMR 519.007(A)(3) and (4). (2) Additional Requirements. The MassHealth agency must have determined (a) that care provided outside an institution is appropriate; and (b) that the estimated cost paid by the MassHealth agency would not be more than the estimated cost paid if the child were institutionalized. (3) Level of Care That Must Be Required in a Hospital. To require the level of care provided in a hospital, the child must have a medical need for the following: (a) direct administration of at least two discrete skilled-nursing services (as defined in 130 CMR 515.001: Definition of Terms) on a daily basis, each of which requires complex nursing procedures, such as administration of intravenous hyperalimentation, changing tracheotomy tubes, assessment or monitoring related to an uncontrolled seizure disorder, assessment or monitoring related to an unstable cardiopulmonary status, or other unstable medical condition; (b) direct management of the child's medical care provided by a physician or directly by someone who is under the supervision of a physician on at least a weekly basis; (c) ongoing use of invasive medical technologies or techniques to sustain life (such as ventilation, hyperalimentation, or gastrostomy tube feeding), or dialysis, or both; and (d) at least one of the following: 1. assistance in one or more activities of daily living (ADLs), as defined in 130 CMR 515.001: Definition of Terms, beyond what is required at an age- appropriate activity level; or 2. one or more skilled therapeutic services (occupational therapy, physical therapy, or speech and language therapy), provided directly by or under the supervision of a licensed therapist at least five times a week. (4) Level of Care That Must Be Required in a Skilled-nursing Facility. To require the level of care provided in a skilled-nursing facility, the child must be nonambulatory and meet the following requirements.