130 CMR, § 519.002

Current through Register 1536, December 6, 2024

Section 519.002 - 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 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.