Sections 15, 16, 17 & 18: MassHealth Eligibility

[unchanged text not shown] (2) The division may, subject to appropriation and the provisions of section nine B, implement MassHealth in accordance with the terms and conditions of a demonstration project, notwithstanding the provisions of any other section of this chapter. MassHealth may provide a program or programs of medical benefits to one or more of the beneficiary categories described in the following clauses: [unchanged text not shown]

(c) children and adolescents, from birth to 18 years, inclusive, whose financial eligibility as determined by the division exceeds 133 per cent but is not more than 300 per cent of the federal poverty level, including such children and adolescents made eligible for medical benefits under this chapter by Title XXI of the Social Security Act. [unchanged text not shown]

 

(h) persons who would be eligible for financial or medical assistance under the foregoing clauses, but for income or resources, except where the terms and conditions of the demonstration project provide for more restrictive or less restrictive eligibility criteria, including the payment of premiums as a condition of eligibility; provided, however, that the division shall not establish disability criteria for applicants or recipients which are more restrictive than the criteria authorized by Title XVI of the Social Security Act, 42 U.S.C. 1381 et seq.

 

(i) persons who have tested positive for the human immunodeficiency virus whose financial eligibility as determined by the division does not exceed 200 per cent of the federal poverty level. [unchanged text not shown] 


(15) Pursuant to section 8B of chapter 62C, the office of Medicaid shall provide written statements to residents of the commonwealth for whom creditable coverage is provided and shall provide a separate report verifying those statements to the commissioner of revenue.

(16) The division shall enroll MassHealth members in available employer-sponsored health insurance if that insurance meets the criteria for MassHealth payment of premium assistance and if federal approval will be obtained to ensure federal reimbursement for premium assistance for that insurance.

 

Summary: 

Expands MassHealth eligibility for children up to 300% of the Federal Poverty Level, increased from the previous 200% of the Federal Poverty Level. • Prevents MassHealth from establishing disability criteria for determining eligibility that is more restrictive than the federal Social Security standards. • Establishes MassHealth eligibility standards for people with HIV at 200% of the Federal Poverty Level. • Requires the Office of Medicaid to provide statements of coverage to enrollees and verify coverage to the commissioner of revenue.