130 CMR, § 519.013

Current through Register 1536, December 6, 2024

Section 519.013 - MassHealth Family Assistance

(A)Eligibility Requirements. MassHealth Family Assistance is available to community residents 65 years of age or older who meet the following requirements:

(1) are qualified noncitizens barred, as described in 130 CMR 518.003(A)(2): Qualified Noncitizens Barred, nonqualified individuals lawfully present, as described in 130 CMR 518.003(A)(3): Nonqualified Individual Lawfully Present, or a nonqualified PRUCOLs, as described in 130 CMR 518.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs)

(a) with the countable income amount, as defined in 130 CMR 520.009: Countable-income Amount, of the individual or married couple living together is less than or equal to 100% of the federal poverty level (FPL);

(b) the countable assets of an individual are $2,000 or less, and those of a married couple living together are $3,000 or less; and

(c) without health insurance, or access to health insurance; or

(2) are nonqualified PRUCOL, as described in 130 CMR 518.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs),

(a) with modified adjusted gross income of the MassHealth MAGI household as described in 130 CMR 506.000: Health Care Reform: MassHealth: Financial Requirements between 100% and 300% of the federal poverty level (FPL); and

(b) without health insurance, or access to health insurance.

(B)Financial Standards Not Met. Individuals described in 130 CMR 519.013(A)(1) whose income, assets, or both exceed the standards set forth in 130 CMR 519.013(A) may establish eligibility for MassHealth Family Assistance by reducing their assets in accordance with130 CMR 520.004: Asset Reduction, meeting a deductible as described at 130 CMR 520.028 through 130 CMR 520.035.

(C)Automatic Eligibility for EAEDC Recipients 65 Years of Age or Older.

(1) 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 qualified noncitizens barred, as described in130 CMR 518.003(A)(2): Qualified Noncitizens Barred, nonqualified individuals lawfully present, as described in 130 CMR 518.003(A)(3): Nonqualified Individuals lawfully present, or nonqualified PRUCOLs, as described in 130 CMR 518.003(C): Nonqualified Persons Residing under Color of Law (Nonqualified PRUCOLs), are automatically eligible for benefits under 130 CMR 519.013.

(2) Individuals whose EAEDC cash assistance ends and who are determined to be potentially eligible for MassHealth continue to receive medical benefits under MassHealth Family Assistance until a determination of ineligibility is made by the MassHealth agency.

(D)Benefits. Individuals eligible for MassHealth Family Assistance are eligible for medical benefits on a fee-for-service basis as defined in 130 CMR 515.001: Definition of Terms. These medical benefits are described in MassHealth regulations at 130 CMR 450.105(G): MassHealth Family Assistance.

(E)Coverage Date. The begin date of medical coverage is established in accordance with130 CMR 516.005: Coverage Date. MassHealth Family Assistance members are eligible for medical coverage under MassHealth Limited if otherwise eligible for MassHealth Limited as described in 130 CMR 519.009.