Page 44

130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 239 Rev. 07/01/21 MASSHEALTH FINANCIAL ELIGIBILITY Chapter 520 Page 520.026 (2 of 4)

(D) Deductions for Maintenance of a Former Home. (1) The MassHealth agency allows a deduction for maintenance of a home when a competent medical authority certifies in writing that a single individual, with no eligible dependents in the home, is likely to return home within six months after the month of admission. This income deduction terminates at the end of the sixth month after the month of admission regardless of the prognosis to return home at that time. (2) The amount deducted is the 100 percent federal-poverty-level income standard for one person.

(E) Deductions for Health-care Coverage and Other Incurred Expenses. (1) Health-Insurance Premiums or Membership Costs. The MassHealth agency allows a deduction for current health-insurance premiums or membership costs when payments are made directly to an insurer or a managed-care organization. (2) Incurred Expenses. (a) After the applicant is approved for MassHealth, the MassHealth agency will allow deductions for the applicant’s necessary medical and remedial-care expenses. These expenses must not be payable by a third party. These expenses must be for medical or remedial-care services recognized under state law but not covered by MassHealth. (b) These expenses must be within reasonable limits as established by the MassHealth agency. The MassHealth agency considers expenses to be within reasonable limits provided they are 1. not covered by the MassHealth per diem rate paid to the long-term-care facility; and 2. certified by a treating physician or other medical provider as being medically necessary. (3) Guardianship Fees and Related Expenses. The MassHealth agency allows deductions from a member’s income for guardianship fees and related expenses when a guardian is essential to enable an incompetent applicant or member to gain access to or consent to medical treatment, as provided below. (a) Expenses Related to the Appointment of a Guardian. 1. The MassHealth agency allows a deduction for fees and expenses related to the appointment of a guardian if the guardian’s appointment is made for the purpose of a. assisting an incompetent applicant to gain access to medical treatment through MassHealth; or b. consenting to medical treatment on behalf of a MassHealth member.