Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 506.000 - Health Care Reform: MassHealth: Financial Requirements › Section 506.015 - 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 506.016:
(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 the following year);
(c) MassHealth Limited members;
(d) MassHealth Medicare Saving Programs
			 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, MassHealth CarePlus, or MassHealth Family
			 Assistance;
(h) members who are
			 former foster care individuals and who are eligible for MassHealth Standard
			 until they reach 21 years old or 26 years old, 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.