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9 130 CMR: DIVISION OF MEDICAL ASSISTANCE

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

130 CMR 519.000: MASSHEALTH: COVERAGE TYPES

(b) have a countable-income amount less than or equal to 300% of the federal benefit rate (FBR) for an individual; and (c) have countable assets of $2,000 for an individual and, for a married couple if the initial waiver eligibility determination was on or after January 1, 2014, have assets that are less than or equal to the standards at 130 CMR 520.016(B): Treatment of a Married Couple’s Assets When One Spouse Is Institutionalized; and (d) not have transferred resources for less than fair market value, as described at 130 CMR 520.018: Transfer of Resources Regardless of the Transfer Date and 520.019: Transfer of Resources Occurring on or after August 11, 1993. (3) Financial Standards Not Met. Individuals whose income, assets, or both exceed the standards set forth in 130 CMR 519.007(B)(2) may establish eligibility for MassHealth Standard by reducing their assets in accordance with 130 CMR 520.004: Asset Reduction, by meeting a deductible as described at 130 CMR 520.028 through 520.035, or by both.

(C) Program of All-inclusive Care for the Elderly (PACE) (1) Overview. PACE is a comprehensive health program that is designed to keep frail, older individuals who are certified eligible for nursing facility services living in the community. (a) A complete range of healthcare services is provided by one designated community- based program, with all medical and social services coordinated by a team of health professionals. (b) The MassHealth agency administers the program in Massachusetts as the Elder Service Plan (ESP). (c) Persons enrolled in PACE have services delivered through managed care 1. in day-health centers; 2. at home; and 3. in specialty or inpatient settings, if needed. (2) Eligibility Requirements. In determining PACE eligibility, the MassHealth agency counts the income and assets of only the applicant or member regardless of their marital status. The applicant or member must meet all of the following criteria: (a) be 55 years of age or older; (b) meet Title XVI disability standards if 55 through 64 years old; (c) be certified by the MassHealth agency or its agent to be in need of nursing facility services; (d) live in a designated service area; (e) have medical services provided in a specified community-based PACE program; (f) have countable assets whose total value does not exceed $2,000 or, if assets exceed these standards, reduce assets in accordance with 130 CMR 520.004: Asset Reduction; and (g) have a countable-income amount less than or equal to 300% of the FBR for an individual. (3) Income Standards Not Met. Individuals whose income exceeds the standards set forth in 130 CMR 519.007(C)(2) may establish eligibility for MassHealth Standard by meeting a deductible as described at 130 CMR 520.028 through 520.035.