Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 515.000 - Masshealth: General Policies
Section 515.003 - MassHealth Coverage Types

Universal Citation: 130 MA Code of Regs 130.515

Current through Register 1531, September 27, 2024

(A) The MassHealth agency provides access to health care by determining eligibility for the coverage type that provides the most comprehensive benefits for a person who may be eligible. Generally, members are provided services on a fee-for-service basis as defined at 130 CMR 515.001.

(B) The MassHealth agency offers the following types of coverage: MassHealth Standard, MassHealth Family Assistance, MassHealth Limited, MassHealth Senior Buy-in, and MassHealth Buy-in. The type of coverage for which a person is eligible is based on the person's and the spouse's income and assets, as described in 130 CMR 519.000: MassHealth: Coverage Types and 520.000: MassHealth: Financial Eligibility, and immigration status, as described in 130 CMR 518.000: MassHealth: Citizenship and Immigration.

(C) The MassHealth agency may limit the number of people who can be enrolled in MassHealth Family Assistance. When the MassHealth agency imposes such a limit, no new applicants 65 years of age or older who are subject to these limitations will be added to MassHealth Family Assistance, and current MassHealth Family Assistance members who have lost eligibility for more than 30 days for any reason will not be allowed to reenroll until the MassHealth agency is able to reopen enrollment for adults.

(1) Applicants who cannot be enrolled under MassHealth Family Assistance pursuant to 130 CMR 515.003(C), will be placed on a waiting list when their eligibility has been determined. When the MassHealth agency is able to open enrollment for adult applicants, the applications will be processed in the order they were placed on the waiting list.

(2) Medical coverage for MassHealth Family Assistance for persons enrolled from a waiting list will begin on the date that the application or new determination is processed from the waiting list.

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