Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 502.000 - Health Care Reform: MassHealth: Eligibility Process › Section 502.006 - Coverage Dates

Current through Register 1525, July 5, 2024
(A)
Start Date of Coverage for Applicants
. For individuals
			 applying for coverage, the date of coverage for MassHealth is determined by the
			 coverage type for which the applicant may be eligible.
			 130 CMR
			 505.000:
Health Care Reform: MassHealth:
			 Coverage Types
describes the rules for establishing this date, except
			 as specified in
			 130
			 CMR 502.003(E)(1), (F)(2), and
			 (H)(2).
(1)
			 The start date of coverage for individuals approved for benefits under
			 provisional eligibility is described at
			 130
			 CMR 502.003(E)(1).
(2) The start date of coverage for
			 individuals who do not meet the requirements for provisional eligibility, as
			 described at
			 130
			 CMR 502.003(E)(2)(a), is
			 described at
			 130
			 CMR 502.006(A)(2)(a) through
			 (d), except individuals described at
			 130
			 CMR 502.006(C).
(a) The start date for individuals who are
			 pregnant or younger than 19 years old who submit all required verifications
			 within the 90-day time frame is described in
			 130
			 CMR 502.006(A)(2)(a)1. and
			 2.
1. If covered medical services were
			 received during such period, and the individual would have been eligible at the
			 time services were provided, the start date of coverage is determined upon
			 receipt of the requested verifications and may be retroactive to the first day
			 of the third calendar month before the month of application except as specified
			 in 130 CMR
			 502.006(C).
2. 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 requested verifications and coverage begins ten days prior to
			 the date of application, except as specified in
			 130
			 CMR
			 506.006(C).
(b) For individuals not described in
			 130
			 CMR 502.006(A)(2)(a) who
			 submit all required verifications within the 90-day time frame, the start date
			 of coverage is determined upon receipt of the requested verifications and
			 coverage begins ten days prior to the date of application, except as specified
			 in 130 CMR
			 502.006(C).
(c) For individuals who fail to provide
			 verifications of information within 90 days of the receipt of the MassHealth
			 agency's request and the MassHealth agency used information received from
			 electronic data sources to determine eligibility, the start date of coverage is
			 determined upon the agency's eligibility determination and coverage begins as
			 described in
			 130
			 CMR 502.006(A)(2)(c)1. and
			 2.
1. For individuals who are pregnant or
			 younger than 19 years old
a. If covered
			 medical services were received during such period, and the individual would
			 have been eligible at the time services were provided, the start date of
			 coverage is determined upon receipt of information received from electronic
			 data sources and may be retroactive to the first day of the third calendar
			 month before the month of application except as specified in
			 130
			 CMR 502.006(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 information received from electronic data sources and coverage
			 begins ten days prior to the date of application, except as specified in
			 130
			 CMR
			 502.006(C).
2. For all other individuals, coverage will
			 begin ten days prior to the date of application, except as specified in
			 130
			 CMR
			 502.006(C).
(d) For individuals denied for failure to
			 provide verification of requested information who then provide requested
			 verifications or report changes after the denial, the start date of coverage is
			 described in
			 130
			 CMR 502.006(A)(2)(d)1. and
			 2.
1. For individuals who are pregnant or
			 younger than 19 years old
a. If covered
			 medical services were received during such period, and the individual would
			 have been eligible at the time services were provided, the start date of
			 coverage is determined upon receipt of the verifications and may be retroactive
			 to the first day of the third calendar month before the received date of the
			 verifications, except as specified in
			 130
			 CMR 502.006(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 verifications and coverage begins ten days prior to the received
			 date of the verifications, except as specified in
			 130
			 CMR 502.006.
2. For all other individuals, coverage will
			 begin ten days prior to the date of receipt of all requested verifications or a
			 reported change, except as specified in
			 130
			 CMR 502.003(D)(2)(d) and
			 502.006(C).