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Medical Assistance in Massachusetts - Overview

The Division of Medical Assistance (DMA) is the single state agency in Massachusetts that administers Medicaid (Title XIX) and the State Children's Health Insurance Program (SCHIP) (Title XXI). In Massachusetts, Medicaid and CHIP are combined into one program called MassHealth. DMA also manages the Insurance Partnership for small businesses, the Program of All-Inclusive Care for the Elderly (PACE) and the Kaileigh Mulligan / Home Care for Disabled Children Program.

Through MassHealth, DMA offers a broad range of health-care services by paying for part or all of a MassHealth member's health insurance, or paying medical providers for services given to MassHealth members. Qualified MassHealth members may be able to get doctor visits, prescription drugs, hospital stays, and many other important services.

MassHealth pays for health care for certain low- and medium-income people living in Massachusetts who are under age 65 and who are not living in nursing homes or other long-term-care facilities.

These include:

·      families with children under age 19.

·      children under age 19.

·      pregnant women.

·      people out of work for a long time.

·      people with disabilities.

·      adults who work for a qualified employer.

DMA offers health-care benefits directly or by paying part or all of member health-insurance premiums.

Certain persons aged 65 or older may also be eligible for MassHealth if they are parents or caretaker relatives of children under age 19, or they have a disability and are working 40 or more hours a month.

DMA makes eligibility determinations and provides the most complete coverage available that members are qualified to receive.

Other Programs

Families with children under the age of 19 who are not eligible for MassHealth or not accessing comparable primary and preventive health care insurance may enroll in the Children's Medical Security Plan (CMSP). The amounts you pay for coverage depend upon your total family size and income and may even be free.

The Bureau of Family and Community Health in the Department of Public Health (DPH) is the state agency responsible for the Children's Medical Security Plan design and for payment of all benefits.

Additional Information

The Division of Health Care Finance and Policy (DHCFP), Executive Office of Health and Human Services compiles and maintains a catalog of program information for all programs of health care coverage for low income persons including those sponsored by public and private organizations. The catalog includes, at a minimum, eligibility criteria, benefits and services offered, enrollment procedures and information necessary for contact and follow up. The catalog, Access to Health Care in Massachusetts is published in PDF format (requires Adobe Acrobat Reader) online at:
http://www.mass.gov/Eeohhs2/docs/dhcfp/pubs/access_catalog.pdf.

The Division of Medical Assistance (DMA) is available on-line at
http://www.mass.gov/dma/.

The Department of Public Health (DPH) is also on-line at:
http://www.mass.gov/dph/dphhome.htm

See also:

MassHealth Application - Overview

MassHealth Covered Services

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