reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 517.000 - MassHealth: Universal Eligibility Requirements › Section 517.008 - Potential Sources of Health Care

Current through Register 1525, July 5, 2024
The MassHealth agency is payer of last resort and pays for
				health care and related services only when no other source of payment is
				available, except as otherwise required by federal law.
(A)
Health
			 Insurance
. Every applicant and member must obtain and maintain
			 health insurance available at no cost to the member including, but not limited
			 to, Medicare and insurance purchased by the MassHealth agency in accordance
			 with
			 130 CMR
			 506.012:
Premium Assistance
			 Payments
. Failure to do so may result in loss of
			 eligibility.
(B)
Use of
			 Benefits
. The MassHealth agency does not pay for any health care
			 and related services that are available
(1)
			 through the member's health insurance, if any; or
(2) at no cost to the member including, but
			 not limited to, any such services that are available through any agency of the
			 local, state, or federal government, or any entity legally obligated to provide
			 those services.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 517.000 - MassHealth: Universal Eligibility Requirements › Section 517.009 - Assignment of Rights to Medical Support and Third-party Payments

Current through Register 1525, July 5, 2024
(A) Every legally able applicant or member
			 must assign to the MassHealth agency his or her rights to medical support and
			 third-party payments for medical benefits provided under Mass-Health as well as
			 the rights of applicants or members for whom he or she can legally assign
			 medical support and third-party payments.
(B) The applicant or member must fully
			 cooperate with the MassHealth agency in
(1)
			 establishing paternity;
(2)
			 obtaining any medical support and payments; and
(3) identifying and providing information to
			 assist the MassHealth agency in pursuing third parties, including a
			 noncustodial parent, who may be legally obligated to pay for care and services
			 for the applicant or member, or person on whose behalf benefits are requested,
			 unless the applicant or member has grounds to waive cooperation as described in
			 130 CMR
			 517.010 or
			 505.002(D):
Eligibility Requirements for Pregnant
			 Women
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 517.000 - MassHealth: Universal Eligibility Requirements › Section 517.010 - Waiver of Cooperation for Good Cause

Current through Register 1525, July 5, 2024
(A)
			 Good cause is established if
(1) with respect
			 to the obligation to establish paternity of a child born out of wedlock, obtain
			 medical-care support and payments, or identify or provide information to assist
			 the MassHealth agency in pursuing a liable third party for a child for whom the
			 applicant or member can legally assign rights, the MassHealth agency finds that
			 cooperation is against the best interest of the child; or
(2) with respect to the obligation to
			 cooperate in all cases not covered by 130 CMR 517.010(A)(1), the MassHealth
			 agency finds that cooperation is not in the best interest of the applicant or
			 member or the person for whom the benefit is being requested or furnished
			 because it is anticipated that cooperation will result in reprisal against, and
			 cause serious physical or emotional harm to, the applicant or member or another
			 person.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 517.000 - MassHealth: Universal Eligibility Requirements › Section 517.011 - Assignment of Rights to Spousal Support

Current through Register 1525, July 5, 2024
An institutionalized spouse, whose community spouse refuses to
				cooperate or whose whereabouts is unknown, will not be ineligible due to
(A) assets determined to be available for the
			 cost of care in accordance with
			 130 CMR
			 520.016(B):
Treatment of a Married Couple's Assets When One Spouse Is
			 Institutionalized
; or
(B)
			 his or her inability to provide information concerning the assets of the
			 community spouse when one of the following conditions is met:
(1) the institutionalized spouse assigns to
			 the MassHealth agency any rights to support from the community
			 spouse;
(2) the institutionalized
			 spouse lacks the ability to assign rights to spousal support due to physical or
			 mental impairment as verified by the written statement of a competent medical
			 authority; or
(3) the MassHealth
			 agency determines that the denial of eligibility, due to the lack of
			 information concerning the assets of the community spouse, would otherwise
			 result in undue hardship.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 517.000 - MassHealth: Universal Eligibility Requirements › Section 517.012 - Assignment for Third-party Recoveries

Current through Register 1525, July 5, 2024
As a condition of eligibility, an applicant or member must
				inform the MassHealth agency when the individual or spouse is involved in an
				accident, or suffers from an illness or injury, or other loss that has resulted
				or may result in a lawsuit or insurance claim. The applicant or member
				must
(A) file an insurance claim for
			 compensation; and
(B) agree to
			 comply with all requirements of M.G.L. c. 118E, § 22 including, but not
			 limited to,
(1) assigning to the MassHealth
			 agency or its agent the right to recover an amount equal to the MassHealth
			 benefits provided from the proceeds of any claim or other proceeding against a
			 third party;
(2) providing
			 information about the claim or any other proceeding, and fully cooperating with
			 the MassHealth agency or its agent, unless the MassHealth agency determines
			 that cooperation would not be in the best interests of, or would result in
			 serious physical or emotional harm to, the applicant or member, in accordance
			 with
			 130 CMR
			 517.010;
(3) notifying the MassHealth agency in
			 writing within ten days of filing any claim, civil action, or other proceeding;
			 and
(4) repaying and cooperating
			 fully with the MassHealth agency or its agent to ensure the member's legal
			 representative repays the MassHealth agency from the money received from a
			 third party for all MassHealth benefits provided on or after the date of the
			 accident or other incident; provided that if the member is involved in an
			 accident or other incident after becoming MassHealth eligible, repayment will
			 be limited to MassHealth benefits provided as a result of the accident or
			 incident.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 518.000 - Masshealth: Citizenship And Immigration › Section 518.001 - Introduction

Current through Register 1525, July 5, 2024
Persons applying for or receiving MassHealth must verify their
				citizenship and identity or immigration status. Citizens and nationals who
				receive Supplemental Security Income (SSI), Social Security Disability
				Insurance (SSDI) based upon disability, or Medicare (including those who are
				entitled to Medicare), and children in receipt of either Title IV-B services or
				Title IV-E adoption assistance or foster care payments do not need to submit
				verification. In addition, a child born to a woman who is eligible for
				MassHealth on the date of the child's birth is exempt from providing
				citizenship and identity verification as described in
				130
				CMR
				518.004(E).
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 518.000 - Masshealth: Citizenship And Immigration › Section 518.002 - U.S. Citizens

Current through Register 1525, July 5, 2024
A citizen of the United States is
(A) an individual who was born in the United
			 States or its territories, including Puerto Rico, the Virgin Islands, Guam, and
			 the Commonwealth of the Northern Mariana Islands (CNMI), except those born to a
			 foreign diplomat, and who otherwise qualifies for U.S. citizenship under §
			 301
et seq
. of the Immigration and Nationality Act
			 (INA);
(B) an individual born of a
			 parent who is a U.S. citizen or who otherwise qualifies for U.S. citizenship
			 under § 301
et seq
. of the INA;
(C) a naturalized citizen; or
(D) a national (both citizen national and
			 noncitizen national) as defined in 130 CMR 518.002(D)(1) or (2).
(1)
Citizen
			 National
. A citizen national is an individual who otherwise
			 qualifies as a U.S. citizen under § 301
et seq
. of the
			 INA.
(2)
Noncitizen
			 National
. A noncitizen national is an individual who was born in
			 one of the outlying possessions of the United States, including American Samoa
			 and Swain's Island, to a parent who is a noncitizen national.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 518.000 - Masshealth: Citizenship And Immigration › Section 518.004 - Verification of U.S. Citizenship and Identity and Immigration Status

Current through Register 1525, July 5, 2024
(A)
U.S. Citizenship and
			 Immigration Status
. MassHealth requires verification of U.S.
			 citizenship or immigration status for all MassHealth applicants, except other
			 noncitizens.
(1) The MassHealth agency will
			 initiate electronic data matches as described in
			 130 CMR
			 516.004:
Matching
			 Information
to attempt to verify U.S. citizenship or immigration
			 status. If electronic data sources are unable to verify U.S. citizenship or
			 immigration status, additional documentation will be required from the
			 individual.
(2) Acceptable proof of
			 U.S. citizenship is described in
			 130
			 CMR 518.005(A)(1) and (2).
			 Individuals who fail to submit proof of U.S. citizenship within 90 days of the
			 MassHealth agency's request will subsequently only be
(a) eligible for Children's Medical Security
			 Plan (CMSP) if they meet the categorical requirements for CMSP described in
			 130 CMR 522.000:
MassHealth: Other Division Programs
; or
(b) eligible for MassHealth Standard for
			 those who are pregnant if they meet the categorical requirements and financial
			 standards described in
			 130 CMR
			 505.002(D):
Eligibility Requirements for Pregnant Women
.
(3) Acceptable proof of
			 immigration status is described in
			 130
			 CMR 518.005(B). Individuals
			 who fail to submit proof of immigration status within 90 days of the MassHealth
			 agency's request will subsequently be eligible
(a) only for MassHealth Limited, if they meet
			 the categorical requirements and financial standards of MassHealth
			 Standard;
(b) for CMSP if they meet
			 the categorical requirements for CMSP described in
			 130 CMR 522.000:
MassHealth: Other Division Programs
; or
(c) for MassHealth Standard if they are
			 pregnant and meet the categorical requirements and financial standards
			 described in
			 130 CMR
			 505.002(D):
Eligibility Requirements for Pregnant Women
;
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 518.000 - Masshealth: Citizenship And Immigration › Section 518.005 - Documents for Verifying U.S. Citizenship and Identity and Immigration Status

Current through Register 1525, July 5, 2024
(A)
Acceptable Proof of U.S.
			 Citizenship and Identity
. Pursuant to
			 130
			 CMR 518.004(B), U.S.
			 citizens must provide proof of both citizenship and identity.
(1)
Acceptable Proof of Both
			 Citizenship and Identity
. The following documents are satisfactory
			 proof of both citizenship and identity:
(a)
			 U.S. passport, including a U.S. Passport Card issued by the Department of
			 State, without regard to any expiration date as long as such passport or Card
			 was issued without limitation;
(b)
			 Certificate of Naturalization;
(c)
			 Certificate of U.S. Citizenship;
(d) a document issued by a federally
			 recognized Indian tribe, as published in the
Federal Register
by the Bureau of Indian Affairs within the U.S. Department of the Interior, and
			 identifies the federally recognized Indian tribe that issued the document,
			 identifies the individual by name, and confirms the individual's membership,
			 enrollment, or affiliation with the tribe. These documents include, but are not
			 limited to, a tribal enrollment card, a Certificate of Degree of Indian Blood,
			 a tribal census document, and documents on tribal letterhead, issued under the
			 signature of the appropriate tribal official that meet the requirements of 130
			 CMR 518.005(A)(1)(d).
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 518.000 - Masshealth: Citizenship And Immigration › Section 518.006 - Applicable Coverage Types

Current through Register 1525, July 5, 2024
(A) Citizens,
			 qualified noncitizens, and protected noncitizens may receive MassHealth under
			 any coverage type for which they are eligible as described in
			 130
			 CMR 519.000:
MassHealth: Coverage
			 Types
.
(B) Qualified
			 noncitizens barred and nonqualified individuals lawfully present may receive
			 the following coverage:
(1) MassHealth Family
			 Assistance if they are adults 65 years of age or older and meet the categorical
			 requirements and financial standards as described in
			 130 CMR
			 519.013:
MassHealth Family
			 Assistance
or are receiving Emergency Aid to the Elderly, Disabled and
			 Children (EAEDC); or
(2) MassHealth
			 Limited if they are adults 65 years of age or older and meet the categorical
			 requirements and financial standards as described in
			 130 CMR
			 519.009:
MassHealth Limited
;
			 or
(3) MassHealth Standard if they
			 are younger than 21 years old or pregnant and meet the categorical and
			 financial requirements described in
			 130 CMR
			 519.006:
Long-term-care
			 Residents
or 519.007:
Individuals Who Would Be
			 Institutionalized
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.001 - Introduction

Current through Register 1525, July 5, 2024
(A)
Categorical Requirements and
			 Financial Standards
.
			 130 CMR
			 519.000 explains the categorical requirements and
			 financial standards that must be met to qualify for a MassHealth coverage type.
			 The rules of financial responsibility and the calculation of financial
			 eligibility are detailed in
			 130 CMR
			 520.000:
MassHealth: Financial
			 Eligibility
.
(B)
MassHealth Coverage Types
. The MassHealth coverage
			 types available to individuals aged 65 and older, institutionalized
			 individuals, and those who would be institutionalized without community-based
			 services are the following:
(1) MassHealth
			 Standard;
(2) MassHealth
			 Limited;
(3) Medicare Savings
			 Programs (MSP) for Qualified Medicare Beneficiaries (QMB) (Senior
			 Buy-In);
(4) Medicare Savings
			 Programs (MSP) for Specified Low Income Medicare Beneficiaries and Qualifying
			 Individuals (Buy-In);
(5)
			 MassHealth CommonHealth; and
(6)
			 MassHealth Family Assistance.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.002 - MassHealth Standard

Current through Register 1525, July 5, 2024
(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
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.003 - Pickle Amendment Cases

Current through Register 1525, July 5, 2024
(A)
Eligibility Requirements
. Under the Pickle Amendment,
			 former SSI recipients whose income exceeds 100% of the federal poverty level
			 are eligible for MassHealth Standard provided they
(1) or their spouse or both are receiving
			 Retirement, Survivors, and Disability Insurance (RSDI) benefits;
(2) were eligible for and received SSI
			 benefits after April 1977;
(3)
			 would be currently eligible for SSI, in accordance with SSI payment standards
			 at130 CMR
			 519.003(B), if the
			 incremental amount of RSDI cost-of-living increases paid to them since the last
			 month subsequent to April 1977, for which they were both eligible for and
			 receiving SSI and entitled to (but not necessarily receiving) RSDI were
			 deducted from the current amount of RSDI benefits. Cost-of-living increases
			 referred to in
			 130
			 CMR 519.003 include increases received by the
			 applicant or member or by the spouse. The spouse need not be otherwise eligible
			 for SSI; and
(4) have countable
			 assets that are $2,000 or less for an individual, and $3,000 or less for a
			 married couple.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.004 - Disabled Adult Children

Current through Register 1525, July 5, 2024
(A)
Eligibility Requirements
. Individuals who lose
			 eligibility for Supplemental Security Income (SSI) benefits may retain
			 eligibility for MassHealth Standard provided that they
(1) are 18 years of age or older;
(2) became blind or disabled before attaining
			 22 years of age;
(3) receive or
			 received SSI based on their blindness or disability;
(4) received an increase in child's insurance
			 benefits under § 202(d) of the Social Security Act, or became entitled to
			 those benefits on the basis of blindness or disability, on or after July 1,
			 1987;
(5) lose or lost SSI as a
			 result of this entitlement or increase in child's insurance benefits under
			 § 202(d) of the Social Security Act; and
(6) would still be eligible for SSI in the
			 absence of such RSDI benefits or increase in benefits.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.005 - Community Residents 65 Years of Age or Older

Current through Register 1525, July 5, 2024
(A)
Eligibility
			 Requirements
. Except as provided in
			 130
			 CMR 519.005(C),
			 noninstitutionalized individuals 65 years of age and older may establish
			 eligibility for MassHealth Standard coverage provided they meet the following
			 requirements:
(1) the countable income amount,
			 as defined in
			 130
			 CMR 520.009:
Countable-income
			 Amount
, of the individual or couple is less than or equal to 100% of
			 the federal poverty level; and
(2)
			 the countable assets of an individual are $2,000 or less, and those of a
			 married couple living together are $3,000 or less.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.006 - Long-term-care Residents

Current through Register 1525, July 5, 2024
(A)
Eligibility Requirements
. Institutionalized
			 individuals may establish eligibility for MassHealth Standard coverage subject
			 to the following requirements. They must
(1)
			 be younger than 21 years old or 65 years of age or older, or, for individuals
			 21 through 64 years of age meet Title XVI disability standards or be
			 pregnant;
(2) be determined
			 medically eligible for nursing facility services by the MassHealth agency or
			 its agent as a condition for payment, in accordance with
			 130 CMR
			 456.000:
Long Term Care
			 Services
;
(3) contribute
			 to the cost of care as defined at
			 130
			 CMR 520.026:
Long-term-care General
			 Income Deductions
;
(4)
			 have countable assets of $2,000 or less for an individual and, for married
			 couples where one member of the couple is institutionalized, have assets that
			 are less than or equal to the standards at
			 130
			 CMR 520.016(B):
Treatment of a Married Couple's Assets when One Spouse is
			 Institutionalized
; and
(5)
			 not have transferred resources for less than fair market value as described at
			 130
			 CMR 520.018:
Transfer of Resources
			 Regardless of Date of Transfer
and 520.019:
Transfer of
			 Resources Occurring on or after August 11, 1993
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.007 - Individuals Who Would Be Institutionalized

Current through Register 1525, July 5, 2024
130 CMR 519.007 describes the
				eligibility requirements for MassHealth Standard coverage for individuals who
				would be institutionalized if they were not receiving home- and community-based
				services.
(A)
The Kaileigh
			 Mulligan Program
. The Kaileigh Mulligan Program enables severely
			 disabled children younger than 18 years old to remain at home. The income and
			 assets of their parents are not considered in the determination of eligibility.
(1)
Eligibility
			 Requirements
. Children younger than 18 years old may establish
			 eligibility for the Kaileigh Mulligan Program by meeting the following
			 requirements. They must
(a)
1. meet Title XVI disability standards in
			 accordance with the definition of permanent and total disability for children
			 younger than 18 years old in
			 130
			 CMR 515.001:
Definition of
			 Terms
or have been receiving SSI on August 22, 1996; and
2. continue to meet Title XVI disability
			 standards that were in effect before August 22, 1996;
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.009 - MassHealth Limited

Current through Register 1525, July 5, 2024
(A)
Eligibility Requirements
.
(1) MassHealth Limited is available to
			 community residents 65 years of age or older meeting the financial and
			 categorical requirements of MassHealth Standard coverage as described at
			 130
			 CMR 519.005(A) and (B) and
			 who are
(a) other noncitizens described in
			 130
			 CMR 518.003(D):
Other Noncitizens
;
(b) qualified noncitizens barred as described
			 in 130 CMR
			 518.003(A)(2):
Qualified Noncitizens Barred
;
(c) nonqualified individuals lawfully present
			 as described in
			 130
			 CMR 518.003(A)(3):
Nonqualified Individuals Lawfully Present
; or
(d) nonqualified PRUCOLs as described in
			 130
			 CMR 518.003(C):
Nonqualified Persons Residing under Color of Law (Nonqualified
			 PRUCOLs)
.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.010 - Medicare Savings Program (MSP) - Qualified Medicare Beneficiaries (QMB)

Current through Register 1525, July 5, 2024
(A)
Eligibility
			 Requirements
. MSP (Buy-in) QMB coverage is available to Medicare
			 beneficiaries who
(1) are entitled to
			 hospital benefits under Medicare Part A;
(2) have a countable income amount (including
			 the income of the spouse with whom he or she lives) that is less than or equal
			 to 190% of the federal poverty level;
(3) Effective until February 29, 2024, have
			 countable assets less than or equal to two times the amount of allowable assets
			 for Medicare Savings Programs as identified by the Centers for Medicare and
			 Medicaid Services. Each calendar year, the allowable asset limits shall be made
			 available on MassHealth's website.
Effective March 1, 2024, MassHealth will disregard all assets
				or resources when determining eligibility for MSP-only benefits;
				and
(4) meet the universal
			 requirements of MassHealth benefits in accordance with
			 130 CMR
			 503.000:
Health Care Reform: MassHealth:
			 Universal Eligibility Requirements
or
			 130 CMR
			 517.000:
MassHealth
:
Universal Eligibility Requirements
, as
			 applicable.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.011 - Medicare Savings Program (MSP) - Specified Low Income Medicare Beneficiaries and Qualifying Individuals

Current through Register 1525, July 5, 2024
(A)
MSP (Buy-in) for Specified Low Income Medicare Beneficiaries
			 (SLMB)
.
(1)
Eligibility Requirements
. MSP is available for
			 Specified Low Income Beneficiaries who
(a)
			 are entitled to hospital benefits under Medicare Part A;
(b) have a countable income amount (including
			 the income of the spouse with whom they live) greater than 190% and less than
			 or equal to 210% of the federal poverty level. MassHealth will disregard all
			 assets or resources when determining eligibility for MSP only
			 benefits;
(c) Effective until
			 February 29, 2024, have countable assets less than or equal to two times the
			 amount of allowable assets for Medicare Savings Programs as identified by the
			 Centers for Medicare and Medicaid Services. Each calendar year, the allowable
			 asset limits shall be made available on MassHealth's website.
Effective March 1, 2024, MassHealth will disregard all assets
				or resources when determining eligibility for MSP-only benefits;
				and
(d) meet the universal
			 requirements of MassHealth benefits in accordance with
			 130 CMR
			 503.000:
Health Care Reform: MassHealth:
			 Universal Eligibility Requirements
or
			 130 CMR
			 517.000:
MassHealth
:
Universal Eligibility Requirements
, as
			 applicable.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.012 - MassHealth CommonHealth

Current through Register 1525, July 5, 2024
(A)
Working Disabled Adults
.
(1)
Eligibility
			 Requirements
. MassHealth CommonHealth for working disabled adults
			 is available to community residents 65 years of age or older in the same manner
			 as it is available to those younger than 65 years old. This means that eligible
			 applicants must meet the requirements of
			 130
			 CMR 505.004(B)(2), (3) and
			 (5) to be eligible for CommonHealth.
(2)
Other
			 Provisions
. The following provisions apply to CommonHealth
			 applicants and members 65 years of age or older:
			 130
			 CMR 505.004(A)(2), (H) through (J), (M)(1) and (2), and
			 (N).
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 519.000 - MassHealth: Coverage Types › Section 519.013 - MassHealth Family Assistance

Current through Register 1525, July 5, 2024
(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
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.001 - Introduction to General Financial Requirements

Current through Register 1525, July 5, 2024
(A) 130 CMR 520.000
			 describes the rules governing financial eligibility for MassHealth. 130 CMR
			 520.000 is based on financial responsibility, countable income, and countable
			 assets.
(B) The methods for the
			 calculation of the countable-income amount, the deductible, and the income
			 standards used in the determination of eligibility are also explained in 130
			 CMR 520.000.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.002 - Financial Responsibility

Current through Register 1525, July 5, 2024
(A)
Community Residents
.
(1)
Spouses Living
			 Together
. In the determination of eligibility for MassHealth, the
			 total countable-income amount and countable assets of the individual and the
			 spouse who are living together are compared to an income standard and asset
			 limit, unless one spouse is covered by MassHealth under a home- and
			 community-based service waiver, as described in
			 130
			 CMR 519.007(B):
Home- and Community-based Services Waiver- Frail
			 Elder
.
(2)
Spouses Living Apart
. When spouses live apart for
			 reasons other than admission to a medical institution, their assets and income
			 are considered mutually available only through the end of the calendar month of
			 separation.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.003 - Asset Limit

Current through Register 1525, July 5, 2024
(A) The total value
			 of countable assets owned by or available to individuals applying for or
			 receiving MassHealth Standard, Family Assistance, or Limited may not exceed the
			 following limits:
(1) for an individual -
			 $2,000; and
(2) for a couple living
			 together in the community where there is financial responsibility according to
			 130
			 CMR 520.002(A)(1)  -
			 $3,000.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.004 - Asset Reduction

Current through Register 1525, July 5, 2024
(A)
Criteria
.
(1) An
			 applicant whose countable assets exceed the asset limit of MassHealth Standard,
			 Family Assistance, or Limited may be eligible for MassHealth
(a) as of the date the applicant reduces his
			 or her excess assets to the allowable asset limit without violating the
			 transfer of resource provisions for nursing-facility residents at
			 130
			 CMR 520.019(F); or
(b) as of the date, described in
			 130
			 CMR 520.004(C), the
			 applicant incurs medical bills that equal the amount of the excess assets and
			 reduces the assets to the allowable asset limit within 30 days after the date
			 of the notification of excess assets.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.005 - Ownership of Assets

Current through Register 1525, July 5, 2024
(A)
General
. Assets owned exclusively by an applicant or
			 member and the spouse are counted in their entirety when determining
			 eligibility for MassHealth, except when assessing assets in accordance with
			 130 CMR
			 520.016.
(B)
Joint Ownership of Assets,
			 Other than Bank Accounts
. Any asset, other than a joint bank
			 account, jointly owned by two or more individuals, is presumed to be owned in
			 equal shares and counted proportionately unless a different distribution of
			 ownership is verified or unless assets are being assessed in accordance with
			 130 CMR 520.016.
			 When such a different distribution of ownership is verified, the MassHealth
			 agency attributes the countable value of the assets to the applicant or member
			 or the spouse in proportion to the ownership interest.
(C)
Joint Bank
			 Accounts
.
(1) Bank accounts are
			 defined at
			 130 CMR
			 520.007(B)(1).
(2) When the applicant or member is a joint
			 owner of a bank account, the entire amount on deposit is considered available
			 to the applicant or member, except when assessing assets in accordance with
			 130 CMR
			 520.016.
(3) If the applicant or member claims partial
			 ownership of the funds in the joint account, he or she must verify the amount
			 owned by each joint depositor. When such a partial ownership is verified, the
			 countable value of the assets is attributed to each owner in proportion to the
			 ownership interest.
(4) The
			 applicant or member may transfer the funds owned by him or her into an account
			 that accurately reflects his or her ownership interest. The MassHealth agency
			 does not consider such a transfer of assets to make oneself eligible for
			 MassHealth if the transfer is completed within 30 days after written
			 notification by the MassHealth agency of this requirement, except in the case
			 of a community spouse as described at
			 130 CMR 520.016
			 who is allowed 90 days to make the transfer.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.006 - Inaccessible Assets

Current through Register 1525, July 5, 2024
(A)
Definition
. An inaccessible asset is an asset to which
			 the applicant or member has no legal access. The MassHealth agency does not
			 count an inaccessible asset when determining eligibility for MassHealth for the
			 period that it is inaccessible or is deemed to be inaccessible under 130 CMR
			 520.006.
(B)
Examples
			 of Inaccessible Assets
. Inaccessible assets include, but are not
			 limited to,
(1) property, the ownership of
			 which is the subject of legal proceedings (for example, probate and divorce
			 suits); and
(2) the cash-surrender
			 value of life-insurance policies when the policy has been assigned to the
			 issuing company for adjustment.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.007 - Countable Assets

Current through Register 1525, July 5, 2024
Countable assets are all assets that must be included in the
				determination of eligibility. Countable assets include assets to which the
				applicant or member or his or her spouse would be entitled whether or not these
				assets are actually received when failure to receive such assets results from
				the action or inaction of the applicant, member, spouse, or person acting on
				his or her behalf. In determining whether or not failure to receive such assets
				is reasonably considered to result from such action or inaction, the MassHealth
				agency considers the specific circumstances involved. The applicant or member
				and the spouse must verify the total value of countable assets. However, if he
				or she is applying solely for Mass-Health Senior Buy-in for Qualified Medicare
				Beneficiaries (QMB) as described in
				130 CMR
				519.010:
MassHealth Senior Buy-in
				(for Qualified Medicare Beneficiaries (QMB))
or MassHealth Buy-in for
				Specified Low Income Medicare Beneficiaries (SLMB) or MassHealth Buy-in for
				Qualifying Individuals (QI) both as described in
				130 CMR
				519.011:
MassHealth Buy-in
,
				verification is required only upon request by the MassHealth agency. 130 CMR
				520.007 also contains the verification requirements for certain assets. The
				assets that the MassHealth agency considers include, but are not limited to,
				the following.
(A)
Cash
.
(1)
Definition
. Cash is defined as currency, checks, and
			 bank drafts in the possession of or available to the applicant, member, or
			 spouse.
(2)
Verification
. The applicant's or member's declaration
			 on the application or redetermination form stating the amount of cash available
			 to him or her is sufficient verification.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.008 - Noncountable Assets

Current through Register 1525, July 5, 2024
Noncountable assets are those assets exempt from consideration
				when determining the value of assets. In addition to the noncountable assets
				described in
				130
				CMR 520.006 and
				520.007, the following assets
				are noncountable.
(A)
The
			 Home
. The home of the applicant or member and the spouse and any
			 land appertaining to the home, as determined by the MassHealth agency, if
			 located in Massachusetts and used as the principal place of residence, are
			 considered noncountable assets, except when the equity interest in the home
			 exceeds the amount described in
			 130
			 CMR 520.007(G)(3). The home
			 is subject to the lien rules at
			 130
			 CMR 515.012:
Real Estate
			 Liens
. If the home is placed in a trust or in an arrangement similar
			 to a trust, the MassHealth agency will apply the trust rules at
			 130
			 CMR 520.021 through
			 520.024.
(B)
Assets of an SSI
			 Recipient
. The assets of an SSI recipient are exempt from
			 consideration as countable assets.
(C)
Proceeds from the Sale of a
			 Home
. The proceeds from the sale of a home used by the applicant
			 or member as the principal place of residence, provided the proceeds are used
			 to purchase another home to be used as the principal place of residence, are
			 considered noncountable assets. Such proceeds are exempt from consideration as
			 countable assets for the three calendar months following the month of receipt.
			 The MassHealth agency places a lien before the death of the member against any
			 real estate in which the member has a legal interest in accordance with
			 130
			 CMR 515.012:
Real Estate
			 Liens
.
(D)
Business and Nonbusiness Property
. Business and
			 nonbusiness property essential to self-support and property excluded under an
			 SSA-approved plan for self-support are considered noncountable
			 assets.
(E)
Any Loan or
			 Grant
. Any loan or grant including, but not limited to,
			 scholarships, the terms of which preclude their use for current maintenance, is
			 considered a noncountable asset.
(F)
Funeral or Burial
			 Arrangements
.
(1) The following
			 funeral or burial arrangements for the applicant, member, or spouse are
			 considered noncountable assets:
(a) any burial
			 space, including any burial space for any immediate family member;
(b) one of the following:
1. a separately identifiable amount not to
			 exceed $1,500 expressly reserved for funeral and burial expenses; or
2. life-insurance policies designated
			 exclusively for funeral and burial expenses with a total face value not to
			 exceed $1,500;
(c) the
			 cash-surrender value of burial insurance; and
(d) prepaid irrevocable burial contracts or
			 irrevocable trust accounts designated for funeral and burial expense.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.009 - Countable-income Amount

Current through Register 1525, July 5, 2024
(A)
Overview
.
(1) An
			 individual's and the spouse's gross earned and unearned income, less certain
			 business expenses and standard income deductions, is referred to as the
			 countable-income amount. In determining gross monthly income, the MassHealth
			 agency multiplies the average weekly income by 4.333, unless the income is
			 monthly.
(2) For community
			 residents, the countable-income amount is compared to the applicable income
			 standard to determine the individual's financial eligibility.
(3) For institutionalized individuals,
			 specific deductions described in
			 130
			 CMR 520.026 are applied against the
			 individual's countable-income amount to determine the patient-paid
			 amount.
(4) The types of income
			 that are considered in the determination of eligibility are described in
			 130
			 CMR 520.009,
			 520.018,
			 520.019, and
			 130
			 CMR 520.021 through
			 520.024. These include income
			 to which the applicant, member, or spouse would be entitled whether or not
			 actually received when failure to receive such income results from the action
			 or inaction of the applicant, member, spouse, or person acting on his or her
			 behalf. In determining whether or not failure to receive such income is
			 reasonably considered to result from such action or inaction, the MassHealth
			 agency will consider the specific circumstances involved.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.010 - Business Expenses

Current through Register 1525, July 5, 2024
(A)
Self-employment
. Allowable business expenses from
			 self-employment are those listed on Schedule C of the U.S. Tax Return
			 form.
(B)
Room and
			 Board
. For the rental of a room only, the MassHealth agency allows
			 25% of the income to be deducted as business expenses. For income from both
			 room and meals, the MassHealth agency allows 75% of the income to be deducted
			 as business expenses. The MassHealth agency allows actual expenses only if the
			 provider can document that they exceed these standard deductions.
(C)
Rental Income
.
(1) Allowable business expenses from rental
			 income include carrying charges, cost of fuel and utilities provided to
			 tenants, and any maintenance and repair costs.
(2) If the individual occupies an apartment
			 in the same building from which he or she receives rental income, carrying
			 charges are prorated per unit. The cost of fuel and utilities are prorated if
			 they are paid through a single heating unit or meter.
(3) The MassHealth agency may deduct actual
			 maintenance and repair costs, other than cosmetic changes, from the amount of
			 rental income if the individual verifies such expenses.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.011 - Standard Income Deductions

Current through Register 1525, July 5, 2024
For community and institutionalized individuals, the MassHealth
				agency allows certain standard earned- and unearned-income deductions from
				gross income. These deductions are described in
				130 CMR
				520.012 through
				520.014.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.012 - Community Earned-income Deductions

Current through Register 1525, July 5, 2024
In addition to business expenses described at
				130 CMR 520.010(A) and
				(B), the MassHealth agency allows the
				following deductions from the gross earned income of each employed individual
				or married couple living in the community. These deductions do not apply to the
				income of a community spouse, as described at
				130 CMR
				520.026(B). Standard
				earned-income deductions are applied in the following order:
(A) $20, if there is no unearned income or,
			 if there is unearned income that is less than $20, the balance of the $20 is
			 disregarded from earned income;
(B)
			 the next $65 a month of earned income; and
(C) one-half of the remaining earned
			 income.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.013 - Community Unearned-income Deductions

Current through Register 1525, July 5, 2024
In addition to business expenses described at
				130 CMR
				520.010, the MassHealth agency allows the
				deductions listed below from the total gross unearned income. These deductions
				do not apply to the income of a community spouse described at
				130 CMR
				520.026(B). The deductions
				allowed from the total gross unearned income are the following:
(A) a deduction of $20 per individual or
			 married couple; or
(B) in
			 determining eligibility for MassHealth Standard, a deduction that is equivalent
			 to the difference between the applicable MassHealth deductible-income standard
			 at
			 130 CMR
			 520.030 and 133% of the federal poverty
			 level. This deduction includes, and is not in addition to, the $20 disregard.
(1) This deduction from gross unearned income
			 is allowed only for persons who
(a) are 65
			 years of age and older;
(b) are
			 receiving personal-care attendant services paid for by the MassHealth agency,
			 or have been determined by the MassHealth agency, through initial screening or
			 by prior authorization, to be in need of personal-care attendant services;
			 and
(c) prior to applying the
			 deduction at 130 CMR 520.013(B), have countable income that is over 100% of the
			 federal poverty level.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.014 - Long-term-care Earned-income Deductions

Current through Register 1525, July 5, 2024
(A)
			 The following expenses may be deducted from the earnings of a
			 long-term-care-facility resident:
(1) a
			 standard deduction of $11; and
(2)
			 any of the following work-related expenses deducted from salary:
(a) social security taxes (FICA);
(b) federal and state income taxes;
(c) retirement and employee benefit
			 plans;
(d) health or medical
			 insurance premiums; and
(e) union
			 dues.
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.015 - Noncountable Income

Current through Register 1525, July 5, 2024
The following types of income are not considered in determining
				the financial eligibility of the applicant or member:
(A) the income of any individual who is a
			 recipient of EAEDC or SSI;
(B) the
			 portion of the income that is disregarded
(1)
			 for disabled adult children according to
			 130
			 CMR 519.004:
Disabled Adult
			 Children
; and
(2) under
			 the Pickle Amendment according to
			 130
			 CMR 519.003:
Pickle Amendment
			 Cases
;
Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 520.000 - MassHealth: Financial Eligibility › Section 520.016 - Long-term Care: Treatment of Assets

Current through Register 1525, July 5, 2024
130 CMR 520.016 describes the
				treatment of countable assets when one member of a couple is institutionalized,
				the post-eligibility transfer of assets, and the allowable income deductions
				for applicants and members who are residents of a long-term-care
				facility.
(A)
Institutionalized Individuals
. The total value of
			 assets owned by an institutionalized single individual or by a member of an
			 institutionalized couple must not exceed $2,000.
(B)
Treatment of a Married
			 Couple's Assets when One Spouse is Institutionalized
.
(1)
Assessment
.
(a)
Requirement
. The
			 MassHealth agency completes an assessment of the total value of a couple's
			 combined countable assets and computes the community spouse's asset allowance
			 as of the date of the beginning of the most recent continuous period of
			 institutionalization of one spouse.
(b)
Right to Request an
			 Assessment
. When one spouse has entered a medical institution and
			 is expected to remain institutionalized for at least 30 days, either spouse may
			 request the MassHealth agency to make this assessment, even if the
			 institutionalized spouse is not applying for MassHealth Standard at that time.
			 The period of institutionalization must be continuous and expected to last for
			 at least 30 days.
(c)
Right to Appeal
. The MassHealth agency must give each
			 spouse a copy of the assessment and the documentation used to make such
			 assessment. Each spouse must be notified that he or she has the right to appeal
			 the determination of countable assets and the community spouse's asset
			 allowance when the institutionalized spouse (or authorized representative)
			 applies for MassHealth Standard.