MassHealth Standard

(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 start date of medical coverage for MassHealth Standard is established in accordance with 130 CMR 519.002(A)(3)(a) through (b). (a) If covered medical services were received during the period for which coverage is requested, and the individual would have been eligible at the time services were provided, the start date of coverage is determined upon receipt of the application and may be retroactive to the first day of the third calendar month before the month of application, pursuant to 42 CFR 435.915. Retroactive eligibility does not apply to services rendered under a home- and community-based services waiver provided under § 1915(c) of the Social Security Act. An application is considered complete if it complies with 130 CMR 516.001(C). (b) If covered medical services were not received during such period, or the individual would not have been eligible at the time services were provided, the start date of coverage is determined upon receipt of the application or upon receipt of any requested verifications, and coverage begins on the first day of the month in which the application was received. (c) If more than one application has been submitted and not denied, the start date of coverage will be based on the earliest application that is approved. (B) Automatic Eligibility for Supplemental Security Income (SSI) Recipients (1) Individuals described in 130 CMR 519.002(A)(1) who meet basic, categorical, and financial requirements under the SSI Program are automatically eligible to receive MassHealth Standard and Medicare Savings Program (MSP) coverage. (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 Emergency Aid to the Elderly, Disabled and Children (EAEDC) Recipients 65 Years of Age and Older (1) Automatic Eligibility. Individuals 65 years of age and older who meet the requirements of the 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 MSP 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 (FPL); (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 FPL; and (3) the deductibles and coinsurance under Medicare Parts A and B for members with a countable income that is less than or equal to 190% of the FPL.