Current through Register 1531, September 27, 2024
(A)
Criteria.
(1) An
applicant whose countable assets exceed the asset limit of MassHealth Standard,
Family Assistance, or Limited may be eligible for MassHealth
(a) as of the date the applicant reduces his
or her excess assets to the allowable asset limit without violating the
transfer of resource provisions for nursing-facility residents at
130
CMR 520.019(F); or
(b) as of the date, described in
130
CMR 520.004(C), the
applicant incurs medical bills that equal the amount of the excess assets and
reduces the assets to the allowable asset limit within 30 days after the date
of the notification of excess assets.
(2) In addition, the applicant must be
otherwise eligible for MassHealth.
(B)
Evaluating Medical
Bills. The MassHealth agency does not pay that portion of the
medical bills equal to the amount of excess assets. Bills used to establish
eligibility
(1) cannot be incurred before the
first day of the third month prior to the date of application as described at
130
CMR 516.002: Date of
Application; and
(2) must
not be the same bills or the same portions of the bills that are used to meet a
deductible based on income.
(C)
Date of
Eligibility. The date of eligibility for otherwise eligible
individuals described at 130 CMR 520.004(A)(1)(b) is the date that his or her
incurred allowable medical expenses equaled or exceeded the amount of his or
her excess assets.
(1) If after eligibility
has been established, an individual submits an allowable bill with a medical
service date that precedes the date established under 130 CMR 520.004(C), the
MassHealth agency readjusts the date of eligibility.
(2) In no event will the first day of
eligibility be earlier than the first day of the third month before the date of
the application, if permitted by the coverage type.
(D)
Verification.
The MassHealth agency requires the applicant to verify that he or she incurred
the necessary amount of medical bills and that his or her excess assets were
reduced to the allowable asset limit within required timeframes.
