10- 144 C.M.R. ch. 103, § IV-4.1
As a condition of eligibility, Program recipients must participate in available employer supported health plans if the Department determines that it is cost effective for it to pay the cost of the plans on behalf of the recipients. If the Department determines that it is not cost effective to contribute toward the cost of the plans, the Department shall not be obligated to contribute toward the cost of the plans.
Enrollment in the plan is a condition of Program eligibility except for an individual who is unable to enroll on his/her own behalf. For example, if a spouse is unable to enroll freely on his/her own behalf, the failure to enroll does not affect the spouse's eligibility for Program benefits.
A recipient who is participating in an employer supported plan must remain enrolled in the plan until the Department completes its cost effectiveness determination. The Department will begin paying premiums as soon as arrangements can be made to do so. The Department will pay the recipient's premium until it completes its cost effectiveness determination at which time it will notify the recipient, in writing, of its determination to continue or discontinue payment.
A recipient who is not participating in an available employer supported plan will be required to enroll if the Department determines it is cost effective to contribute toward the cost of the plan of behalf of the recipient. Recipients must provide the Department with proof of enrollment no later than thirty (30) days from the date of the cost effectiveness determination. Recipients who are unable to enroll in an employer supported plan must notify the Department no later than thirty (30) days from the date of behalf effectiveness determination notice as to their reason for not enrolling. Recipients will have the opportunity to claim good cause (e.g. enrollment period not open) for not enrolling. Good cause will be established by the Bureau of Medical Services' Third Party Liability Unit.
The recipient is responsible for reporting any changes in employer supported health plan benefits or premiums to the Department as soon as they are known.
10- 144 C.M.R. ch. 103, § IV-4.1