Aging out of MassHealth

How to maintain coverage for older teens in adult foster care

Adult Foster Care can sometimes be a misleading term. Although it contains the word “adult,”  if you review the eligibility requirements for this type of state-assisted at-home care, it can also cover teens 16 or older if their condition prevents them from living alone and completing at least one activity of daily living.

But MassHealth, the Massachusetts medicaid system, is only available to children up to the age of 18. So what happens to Massachusetts teens in adult foster care once they age out of MassHealth?

How to cover disabled children ages 19–26

In Massachusetts, teenagers on MassHealth will generally age out of the program when they turn 19 years old. While MassHealth does provide coverage to children up to age 18, once a child turns 19, they are no longer eligible for MassHealth under the standard child eligibility criteria.

At that point, a child with disabilities could be covered if they meet one of the following conditions:

• They become mentally or physically incapable of earning their own living prior to age 19
• They became permanently and totally disabled on or after age 19 

These dependents will only be covered until the last day of the month they turn 26.

Who is Eligible for MassHealth?

MassHealth has basic requirements based on your residence, immigration status and financial situation.

Residential Requirements:

You meet the residential requirements if you currently live in Massachusetts or have entered Massachusetts with a job commitment or seeking employment

Citizenship Requirements:

To receive MassHealth, Health Safety Net, or Children’s Medical Security Plan coverage, your citizenship or satisfactory immigration status must be verified.

Financial Requirements:

To determine your financial eligibility for MassHealth, the state uses a calculation based on your Modified Adjusted Gross Income (MAGI) and the members of your household.

What are the Types of MassHealth Coverage for Young Adults?

The different types of MassHealth coverage have different eligibility requirements, ensuring the most opportunities for coverage are available to the state’s most vulnerable populations.

MassHealth Standard:

Primarily for low-income individuals and families who may not be able to afford private health insurance, MassHealth Standard adheres to specific income limits, often based on a percentage of the Federal Poverty Level (FPL). While not specifically designed for individuals with disabilities, it can cover disabled adults if they meet the income requirements. MassHealth also offers certain behavioral health services for eligible children and youth under 21 who are enrolled in MassHealth Standard or MassHealth CommonHealth.

MassHealth CommonHealth:

MassHealth CommonHealth offers health care benefits similar to MassHealth Standard to certain disabled adults and disabled children who cannot get MassHealth Standard because their household income exceeds the eligibility requirements. Individuals with incomes exceeding the limits for Standard coverage may be eligible, often with a sliding-scale monthly premium. If your child is not eligible for MassHealth Standard and a behavioral health evaluation shows that your child has significant mental health needs or a serious emotional disturbance, they may be eligible for MassHealth CommonHealth.

MassHealth CarePlus

MassHealth CarePlus offers a broad range of health care benefits to adults who are not otherwise eligible for MassHealth Standard but does not cover the same long-term services and supports as MassHealth Standard. Members typically enroll in a Managed Care Organization (MCO) for many covered services, with some services like transportation, dental, and eyeglasses directly covered by MassHealth. Individuals in CarePlus who require long-term services and supports can potentially upgrade to MassHealth Standard

MassHealth Family Assistance

MassHealth Family Assistance primarily serves families with children, including those with children under 19, and some lawfully present immigrants who may not qualify for MassHealth Standard. It often provides premium assistance to help families pay for employer-sponsored health insurance (ESI). It can also cover some out-of-pocket costs not covered by ESI. MassHealth Family Assistance may have less stringent income requirements for some individuals, particularly children, and may be available to those not eligible for MassHealth Standard

MassHealth Limited

MassHealth Limited provides emergency health services to people who have an immigration status that keeps them from getting more services. Primarily for emergency medical services, MassHealth Limited is often used for individuals with certain immigration statuses who don’t qualify for other MassHealth coverage types. 

Making the Right Choice with Mass Care Link

If you take care of an older with disabilities teen at home, you may be eligible for Adult Foster Care from MassCare Link. We will guide you through any transitions in your MassHealth coverage, ensuring you have the resources to care for the people who matter most.