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5 130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 259 Rev. 02/13/26

130 CMR 522.000: MASSHEALTH: OTHER DIVISION PROGRAMS

522.003: Adoption Assistance and Foster Care Maintenance

Any child placed in subsidized adoption or foster care under Title IV-E of the Social Security Act is automatically eligible for medical assistance provided by the state where the child resides.

(A) Children receiving state-subsidized adoption payments from a state that is a member of the Interstate Compact on Adoption and Medical Assistance (ICAMA) will be eligible for medical assistance provided by the state where the child resides if that state is a member of ICAMA.

(B) Children receiving state-subsidized adoption payments from a state that is not a member of ICAMA, or any child receiving state-subsidized foster-care payments, will only be eligible for medical assistance provided by their state of origin.

522.004: Children’s Medical Security Plan (CMSP)

(A) Regulatory Authority. CMSP is administered pursuant to M.G.L. c. 118E, § 10F.

(B) Overview. CMSP provides coverage to uninsured children younger than 19 years of age who do not qualify for any other MassHealth coverage type, other than MassHealth Limited, and who do not have physician and hospital healthcare coverage. To apply for these benefits, an applicant must submit an application as described in 130 CMR 502.001: Application for Benefits and 502.002: Reactivating the Application.

(C) Eligibility Requirements. Children are eligible for CMSP if they are (1) a resident of Massachusetts, as defined in 130 CMR 503.002: Residence Requirements; (2) younger than 19 years of age; (3) not otherwise eligible for any other MassHealth coverage type, other than MassHealth Limited. Children who are otherwise eligible, and who are not receiving MassHealth coverage as a result of not complying with administrative requirements of MassHealth, are not eligible for CMSP. Children who lose eligibility for MassHealth Family Assistance as a result of nonpayment of premiums, or as a result of not enrolling in employer-sponsored health insurance through Premium Assistance, are not eligible for CMSP; and (4) uninsured. An applicant or member is uninsured if they (a) do not have insurance that provides physician and hospital healthcare coverage; (b) have insurance that is in an exclusion period; or (c) had insurance that has expired or has been terminated.

(D) Premiums. The premium schedule and payment policies for CMSP are described in 130 CMR 506.011: MassHealth and the Children’s Medical Security Plan (CMSP) Premiums.