Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 519.000 - MassHealth: Coverage Types
Section 519.002 - MassHealth Standard
Universal Citation: 130 MA Code of Regs 130.519
Current through Register 1531, September 27, 2024
(A) Overview.
(1)
130
CMR 519.002 through
130
CMR 519.007 contain the categorical
requirements and asset and income standards for MassHealth Standard, which
provides coverage for individuals aged 65 and older, institutionalized
individuals, and those who would be institutionalized without community-based
services.
(2) Individuals eligible
for MassHealth Standard are eligible for medical benefits on a fee-for-service
basis as defined in
130
CMR 515.001: Definition of
Terms. The medical benefits are described in
130
CMR 450.105(A):
MassHealth Standard.
(3) The begin date of medical coverage for
MassHealth Standard is established in accordance with
130
CMR 516.005: Time Standards for
Eligibility Determination.
(B) Automatic Eligibility for SSI Recipients.
(1) Individuals
described in
130
CMR 519.002(A)(1) who meet
basic, categorical, and financial requirements under the Supplemental Security
Income (SSI) program are automatically eligible to receive MassHealth Standard
and Medicare Savings Programcoverage.
(2) Eligibility for retroactive coverage must
be established by the MassHealth agency in accordance with
130
CMR 516.005: Time Standards for
Eligibility Determination.
(C) Extended Eligibility for SSI Recipients. An individual whose SSI assistance has been terminated, and who is determined to be potentially eligible for MassHealth, continues to receive MassHealth Standard coverage until a determination of ineligibility is made by the MassHealth agency.
(D) Automatic and Extended Eligibility for EAEDC Recipients 65 Years of Age or Older.
(1)
Automatic
Eligibility. Individuals 65 years of age or older who meet the
requirements of the Emergency Aid to the Elderly, Disabled and Children (EAEDC)
program administered by the Department of Transitional Assistance and who are
United States citizens as described in
130
CMR 518.002: U.S. Citizens
or qualified noncitizens, as described in
130
CMR 518.003(A)(1):
Qualified Noncitizens, are automatically eligible for
MassHealth Standard benefits.
(2)
Extended Eligibility. Individuals described in
130
CMR 519.002(D)(1) whose
EAEDC cash assistance ends will continue to receive MassHealth Standard
benefits until the MassHealth agency determines that the member is
ineligible.
(E) Medicare Premium Payment. The MassHealth agency, in accordance with the Medicare Savings Program as described at 130 CMR 519.010 and 519.011, pays the following:
(1) Medicare Part B premiums for members with
countable income that is less than or equal to 225% of the federal poverty
level;
(2) Medicare Part A premiums
for adult members of MassHealth Standard who are entitled to Medicare Part A
with a countable income that is less than or equal to 190% of the federal
poverty level; and
(3) the
deductibles and coinsurance under Medicare Parts A and B for members with
acountable income that is less than or equal to 190% of the federal poverty
level.
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