Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.037 - Copayment and Cost Sharing Requirement Exclusions

Current through Register 1525, July 5, 2024
(A)
Excluded
			 Individuals
.
(1) The following
			 individuals do not have to pay the copayments described in
			 130
			 CMR 520.038:
(a) members younger than 21 years
			 old;
(b) members who are pregnant
			 or in the postpartum period that extends through the last day of the
			 12th calendar month following the month in which
			 their pregnancy ends (for example, if the woman gave birth May
			 15th, she is exempt from the copayment requirement
			 until June 1st of the following year);
(c) MassHealth Limited members;
(d) MassHealth Senior Buy In members or
			 MassHealth Standard members for drugs covered under Medicare Parts A and B
			 only, when provided by a Medicare-certified provider;
(e) members who are inpatients in nursing
			 facilities, chronic-disease or rehabilitation hospitals, or intermediate care
			 facilities for individuals with intellectual disabilities or who are admitted
			 to a hospital from such a facility or hospital;
(f) members receiving hospice
			 services;
(g) persons receiving
			 medical services through the Emergency Aid to the Elderly, Disabled and
			 Children Program pursuant to
			 130
			 CMR 450.106:
Emergency Aid to the
			 Elderly, Disabled and Children Program
, if they do not receive
			 MassHealth Standard, or MassHealth Family Assistance;
(h) members who are former foster care
			 individuals and who are eligible for MassHealth Standard until they reach the
			 age of 21 or the age of 26, as specified in
			 130
			 CMR 505.002(H): Eligibility
			 Requirements for Former Foster-Care Individuals;
(i) members who are American Indians or
			 Alaska Natives who are currently receiving or have ever received an item or
			 service furnished by the Indian Health Service, an Indian tribe, a tribal
			 organization or an urban Indian organization, or through referral, in
			 accordance with federal law.
(j)
			 "referred eligible" members, who are:
1.
			 persons who receive Supplemental Security Income (SSI) benefits from the Social
			 Security Administration (SSA) and who receive MassHealth Standard under
			 130
			 CMR 505.002(A)(2)  or
			 130
			 CMR 519.002(B);
2. persons who receive Transitional Aid to
			 Families with Dependent Children (TAFDC) cash assistance from the Department of
			 Transitional Assistance (DTA) and who receive MassHealth Standard under
			 130
			 CMR 505.002(A)(3);
3. children, young adults, and parents and
			 caretaker relatives who receive Emergency Aid to the Elderly, Disabled and
			 Children (EAEDC) cash assistance and who receive MassHealth Standard under
			 130
			 CMR 505.002(K)  or
			 130
			 CMR 519.002(D), MassHealth
			 Family Assistance under
			 130
			 CMR 505.005(G)  or
			 130
			 CMR 519.013(C), or
			 MassHealth CarePlus under
			 130
			 CMR 505.008(B);
4. children receiving medical assistance
			 under
			 130
			 CMR 522.003:
Adoption Assistance and
			 Foster Care Maintenance
, because they are receiving Title IV-E or
			 state-subsidized adoption or foster-care assistance
5. persons who receive extended eligibility
			 for MassHealth Standard under
			 130
			 CMR 505.002(L)(1) and (2) or
			 130
			 CMR 519.002(C);
			 and
6. persons who receive
			 MassHealth Standard or CarePlus because they are eligible for Refugee Medical
			 Assistance (RMA) under
			 130
			 CMR 522.002:
Refugee Resettlement
			 Program
; and
(k)
			 members whose applicable income for the purposes of calculating copayments is
			 at or below 50% of the FPL when adjusted for family size.