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MassHealth

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MassHealth

Information on MassHealth programs. MassHealth is the state program that provides free health care to some low income individuals and families.

MassHealth

MASS HEALTH PROGRAMS

“MassHealth is a public health insurance program for eligible low and medium-income residents of Massachusetts. MassHealth is the name used in Massachusetts for Medicaid and the State Children's Health Insurance Plan (SCHIP), combined in one program. MassHealth includes several different health plans“

COVERAGE TYPES

Mass Health Standard: Comprehensive health insurance, including preventive and medical services, prescription drugs and hospitalization
Common-Health:Comprehensive health insurance program for individuals with disabilities
Mass Health Basic: Health benefits or premium assistance from EAEDC recipients or low-income, long-term unemployed Dept. of Mental Health clients
Mass Health Family Assistance: Health insurance for children under 19 and individuals with HIV who do not qualify for Mass Health Basic.
Premium Assistance: Helps pay for employer-provided health insurance for some employed adults
Mass Health Limited: Emergency medical coverage for undocumented noncitizens * Medicare Buy-In: Pays all or part of Medicare expenses
Mass Health Prenatal: Short-term, outpatient care for pregnant women
Mass Health Essential: Health insurance for long-term unemployed adults and some non-citizens with “special status”

ELIGIBILITY

Mass Health eligibility is two-part: categorical and financial, both standards must be met to receive Mass Health benefits.

Online Eligibility Check

http://massresources.org/pages.cfm?contentID=35&pageID=13&subpages=yes&dynamicID=567

CATEGORICAL ELIGIBILITY

People who are:

Under 19 years old
Living with children under 19 years old
Pregnant
Clients of the Department of Mental Health and long-term unemployed
Employees of qualified businesses
HIV positive
Over age 65
Women with breast or cervical cancer
In need of long term care

FINANCIAL ELIGIBILTY

Gross monthly income is less than the amount listed for family size and eligibility criteria:

Key:

Group 1: Seniors, Long term unemployed, or Dept. of Mental Health clients

Group 2: Parents/Caretakers, Disabled adults

Group 3: Children 1-18yrs

Group 4: Pregnant women, some workers, some children, HIV+ individuals

Group 5: Women with breast or cervical cancer

Family	Group 1	Group 2	Group 3	Group 4	Group 5
1	$817	$1,087	$1,250	$1,634	$2,042
2	$1,100	$1,463	$1,650	$2,200	$2,750
3	$1,384	$1,840	$2,075	$2,767	$3,459
4	$1,667	$2,217	$2,500	$3,334	$4,167
5	$1,950	$2,594	$2,925	$3,900	$4,875
6	$2,234	$2,971	$3,350	$4,467	$5,584
7	$2,517	$3,348	$3,775	$5,034	$6,292
8	$2,800	$3,724	$4,200	$5,600	$7,000
each +	+$284	+$377	+$425	+$567	$709

BENEFITS

Mass Health includes eight different plans, with different coverage, plans include some of the benefits listed:

• Inpatient care at hospitals or other medical facilities, including: nursing services, rehabilitation services, long-term care

acute care

• Outpatient care in doctor's offices, clinics, hospitals, etc., including: office visits, preventive care, family planning, abortion services

• Tests, medical equipment, and medical services, including: diagnostic tests, X-rays

radiology services, hearing tests, vision tests, eyeglasses, and visual aids, medical equipment and supplies, therapy services, orthotics and prosthetics, renal dialysis service

• Well-child services for children under 21, including: checkups, vision and hearing screenings, early intervention, immunizations

• Substance abuse treatment (inpatient and outpatient)

• Mental health services (inpatient and outpatient)

• Dental services, including: cleanings and checkups, fillings, root canals, and certain other approved procedures, dentures

• Prescription drugs for non-Medicare recipients

• Tobacco cessation services, including:

group or individual counseling, nicotine replacement medicine,

• Other services, including: home health care, community-based long-term care, hospice services, transportation services, adult foster care, adult day care, chiropractic services

PREMIUMS & CO-PAYS

Mass Health Standard:
- No monthly premiums for pregnant women, Children under 6, Families with incomes up to 133% Federal Poverty Guideline (FPG), Disabled adults with incomes to 114% FPG, Seniors
- $12 monthly premiums for children 6-18 with income over 133% Federal Poverty Guideline (FPG) , Disabled adults with income over 114% FPG
- Sliding scale premiums for Women with breast or cervical cancer (premium based on income)
- Co-pay for prescription drugs for most adults
Common Health: Sliding scale monthly premium based on income
Mass Health Family Assistance
- $27 Premium for Employed adults without children
- Sliding Scale for families with children under 19. ($12 per child and family maximum $15 to $28 per child and $84 family maximum)
- HIV+ individuals – premium depends on income
Mass Health Basic: No premiums, but co-payments on prescription medications
Mass Health Limited: No fees
Medicare Buy-In: No fees, but responsible for any Medicare expenses not covered
Mass-Health Pre-natal: No fees
Mass-Health Essential: No premium, but co-pay for prescription drugs and non-emergency services provided in hospital emergency room.

Federal Poverty Guidelines – 2006

Annual Income by Family/Household Size

People	FPG	114% FPG	133% FPG
1	$9,800	$11,172	$13,034
2	$13,200	$15,048	17,556
3	$16,600	$18,924	$22,078
4	$20,000	$22,800	$26,600
5	$23,400	$26,676	$31,122
6	$26,800	$30,552	$35,644
7	$30,200	$34,428	$40,166
8	$33,600	$38,304	$44,688
each +	$3,400	$3,876	$4,522

Source: US Dept. of Health & Human Services.

APPLICATION PROCESS

GET AN APPLICATION:

By calling Mass Health Enrollment Center at 1.888.665.9993 (TTY 1.888.665.9997)
Calling or visiting the local Department of Transitional Assistance office
Get an application online: http://www.mass.gov/Eeohhs2/docs/masshealth/appforms/mbr.pdf

Apply at a Community Health Centers :

SEND COMPLETED APPLICATION TO:

Mass Health Enrollment Center

Central Processing Unit

PO Box 290794

Charleston, MA 02129-0214

DOCUMENTATION:

You will need some or all of these documents. If you do not have some of them, you may be allowed to use a sworn statement from someone else.

Proof of Identity
Proof of citizenship or immigration status (green card etc.)
Birth dates for all family members
Social security numbers (Except for Mass Health Limited)
Verification of disability determination
Copies of recent pay-stubs
Bank Statements
Documentation of other income (TAFDC, SSI, child support, pension etc.)
Tax returns/ business records if self-employed or have rental income
Copy of card for any health insurance you already have

Documentation of HIV status (if applying based on that status)

TIMELINE

If Mass Health needs more information or documentation they should notify you within 5 DAYS of receiving your application
If Mass Health requests additional information, you must submit it within 30 DAYS of the request
If you are not disabled, and your application complete, Mass Health must make a decision on your eligibility within 45 DAYS
If you have a disability your application can take up to 90 DAYS
Mass Health does not have a time limit, you can continue to receive benefits as long as you remain eligible.
If your coverage will be terminated, reduced or otherwise changed, Mass Health will issue written notice 10 DAYS in advance.

MASS HEALTH AND OTHER INSURANCE

To get/keep Mass Health you must:

Apply and enroll in any no-cost health care (eg Medicare)
Enroll in health insurance when Mass Health determines it is cost effective
Keep any health insurance you already have
Give Mass Health any information about insurance you already have or may be able to get.

Mass Health will use information on your other insurance to decide

If it meets Mass Health’s standards
If and how much Mass Health may pay towards your premiums

RIGHTS:

Personal information is confidential
You may not be discriminated against based on race, color, sex, age, country of origin, religion, sexual orientations, creed or dis/ability status
You have a right to request a hearing to appeal decisions about your eligibility, benefits and/or services
If you qualify for multiple programs, you can enroll in the one with the most complete coverage
You can get an interpreter or Mass Health information in languages other than English
You may designate a friend, relative or other person as your “eligibility representative”