Current through Register 1543, March 14, 2025
(A)
Overview.
130
CMR 505.006 contains the categorical
requirements and financial standards for MassHealth Limited coverage for
children, young adults, and adults 21 through 64 years old who are parents,
caretakers, adults, and disabled adults.
(B)
Eligibility
Requirements.
(1) MassHealth
Limited is available to the following:
(a)
other noncitizens as described in
130
CMR 504.003(D):
Other Noncitizens who are
1.
children younger than one year old with modified adjusted gross income of the
MassHealth MAGI household that is less than or equal to 200% of the federal
poverty level (FPL);
2. children one
through 18 years old with modified adjusted gross income of the MassHealth MAGI
household that is less than or equal to 150% of the FPL;
3. young adults 19 through 20 years old with
modified adjusted gross income of the MassHealth MAGI household that is less
than or equal to 150 % of the FPL;
4. adults 21 through 64 years old who are
parents, caretakers, or adults with modified adjusted gross income of the
MassHealth MAGI household that is less than or equal to 133% of the FPL;
and
5. disabled adults 21 through
64 years old with modified adjusted gross income of the MassHealth Disabled
Adult household that is less than or equal to 133% of the FPL;
(b) nonqualified PRUCOLs as
described in
130
CMR 504.003(C):
Nonqualified Persons Residing under Color of Law (Nonqualified
PRUCOLs) who are
1. children younger
than one year old with modified adjusted gross income of the MassHealth MAGI
household that is less than or equal to 200% of the federal poverty level
(FPL);
2. children one through 18
years old with modified adjusted gross income of the MassHealth MAGI household
that is less than or equal to 150% of the FPL;
3. young adults 19 through 20 years old with
modified adjusted gross income of the MassHealth MAGI household that is less
than or equal to 150% of the FPL;
4. adults 21 through 64 years old who are
parents, caretakers, or adults with modified adjusted gross income of the
MassHealth MAGI household that is less than or equal to 133% of the FPL;
and
5. disabled adults 21 through
64 years old with modified adjusted gross income of the MassHealth Disabled
Adult household that is less than or equal to 133% of the FPL;
(c) qualified noncitizens barred,
as described in
130
CMR 504.003(A)(2):
Qualified Noncitizens Barred, and nonqualified individuals
lawfully present, as described in130 CMR
504.003(A)(3):
Nonqualified Individuals Lawfully Present, who are
1. adults, including parents and caretaker
relatives, 21 through 64 years old with modified adjusted gross income of the
MassHealth MAGI household that is less than or equal to 133% of the
FPL;
2. disabled adults 21 through
64 years old with modified adjusted gross income of the MassHealth Disabled
Adult household that is less than or equal to 133% of the FPL;
3. parents and caretakers who are 21 through
64 years old who are receiving EAEDC; and
4. adults 21 through 64 years old who are
receiving EAEDC.
(2) Nonqualified PRUCOLs eligible for
MassHealth Limited in
130
CMR 505.006(B)(1)(b) and
qualified noncitizens barred and nonqualified individuals lawfully present
eligible for MassHealth Limited in
130
CMR 505.006(B)(1)(c) may
also be eligible for MassHealth CommonHealth if they meet the categorical and
financial requirements in
130
CMR 505.004 or MassHealth Family Assistance
if they meet the categorical and financial requirements in130 CMR
505.005.
(3) Persons eligible for MassHealth Limited
coverage are eligible for medical benefits as described in
130
CMR 450.105(F):
MassHealth Limited. These individuals are eligible for medical
benefits under MassHealth Limited only to the extent that such benefits are not
covered by their health insurance.
(C)
Use of Potential Health
Insurance Benefits. All individuals who meet the requirements
of130 CMR 505.006, must use
potential health insurance benefits in accordance with
130
CMR 503.007: Potential Sources of
Health Care, and must enroll in health insurance, including Medicare,
if available at no greater cost to the applicant or member than they would pay
without access to health insurance. Members must access those other health
insurance benefits and must show both their private health insurance card and
their MassHealth card to providers at the time services are provided.
(D)
Medical Coverage
Date.
(1) The medical coverage
date for MassHealth Limited is described at
130
CMR 502.006:
Coverage Dates,
except as described at
130
CMR 505.006(D)(2).
(2) Provisional eligibility is described in
130
CMR 502.003(E):
Provisional Eligibility.
(E)
Referral to Children's
Medical Security Plan. MassHealth submits the names of children
who are eligible for MassHealth Limited coverage to the Children's Medical
Security Plan.
