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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 239 Rev. 07/01/21 MASSHEALTH FINANCIAL ELIGIBILITY Chapter 520 Page 520.028

520.028: Eligibility for a Deductible

The following individuals may establish eligibility by meeting a deductible:

(A) former SSI recipients who are not eligible under the Pickle Amendment;

(B) community-based individuals whose countable-income amount exceeds the 100 percent federal poverty level income standards;

(C) long-term-care-facility residents whose income, after general deductions described in 130 CMR 520.026, exceeds the public rate in a long-term-care facility;

(D) disabled adult children whose incomes exceed the standards set forth in 130 CMR 519.004(A): Eligibility Requirements; and

(E) persons who are eligible for an increased disregard as described at 130 CMR 520.013(B).

520.029: The Deductible Period

The deductible period is a six-month period that starts on the first day of the month of application or may begin up to three months before the first day of the month of application. The applicant is eligible for this period of retroactivity only if the applicant incurred medical expenses covered by MassHealth and was otherwise eligible.

520.030: Calculating the Deductible

The deductible is determined by multiplying the excess monthly income by six. Excess monthly income is the amount by which the applicant's countable-income amount as described in 130 CMR 520.009 exceeds the MassHealth deductible-income standard.

MASSHEALTH DEDUCTIBLE-INCOME STANDARDS

Number of Persons

1 2

Monthly-Income Standard for Community Residents

$522

650

Monthly-Income Standard for

Long-term-care-facility Residents

$72.80