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MassHealth Standard Overview

This topic provides an explanation of the non-financial eligibility criteria and the covered services for the MassHealth Standard plan. Note that you must also meet the financial eligibility criteria.

Non-Financial Eligibility Criteria

You may be able to get MassHealth Standard if you are:

·      Pregnant;

·      under age 19;

·      a parent living with your children under age 19;

·      an adult caretaker relative living with children under age 19 to whom you are related and for whom you are the primary caretaker when neither parent is living in the home;

·      have a disability according to the standards set by federal law. This means you have a mental or physical condition that limits or prevents you from working for at least 12 months (the Division of Medical Assistance (DMA) decides if you meet the disability standards); or

·      eligible for Transitional Medical Assistance (TMA), which let you and your children keep these benefits for up to 12 months after you have returned to work or gotten a raise, no matter how much your new earnings are. TMA benefits are available for parents and caretaker relatives of children under 19.

To be eligible for MassHealth Standard you must also meet the financial eligibility criteria.

Covered Services

In MassHealth Standard, covered services include the ones listed below. There may be some limits. Your health-care provider can explain them.

·      Inpatient hospital services

·      Outpatient services: hospitals, clinics, doctors, dentists (limited dental coverage for adults), family planning, and home-health care

·      Medical services: lab tests, X-rays, therapies, pharmacy services, dental services, eyeglasses, hearing aids, medical equipment and supplies, adult day health, and adult foster care

·      Mental health and substance abuse services: inpatient and outpatient

·      Well-child screenings (for children under the age of 21): including medical, vision, dental, and hearing tests, as well as shots and prescription and nonprescription drugs

·      For adults with disabilities who also get Medicare Part B: payment of the Medicare premium, coinsurance, and deductibles

·      Transportation services

Additional Information

For a complete list of the covered services, see: MassHealth Standard Covered Services.

NOTE: On November 1st, 2003, the Massachusetts Department of Medical Assistance (DMA) began charging premiums to some MassHealth Standard beneficiaries. Those who are eligible because of having a disability must pay a premium of $12 per month if their family income is greater than 114% of the Federal Poverty Level (FPL). Those who are eligible because they are children (less than 19 years old) must pay a premium of $12 ($15 if there are two or more children) if their family income is greater than 133% of FPL. Those who are eligible because they are pregnant or under 6 years old do not have to pay premiums. For detailed information see M506.011 of the DMA Medicaid Manual, available online in PDF format (requires Adobe Acrobat Reader) at:
http://www.mass.gov/Eeohhs2/docs/masshealth/regs_member/regs_memb_506.pdf

Also see:

MassHealth Standard - Financial Eligibility

MassHealth

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