MassHealth Insurance: Medicaid of Massachusetts
What is MassHealth?
MassHealth Insurance, also referred to as Medicaid of Massachusetts is a state-based health insurance program that provides health coverage to individuals depending on their income. In Massachusetts, this insurance type is considered to be the 3rd most commonly availed health insurance coverage after Medicare & private insurance.
Who can benefit from MassHealth Insurance?
Those not able to qualify for Medicare or afford private insurance can benefit from MassHealth. There are several programs offered through MassHealth containing different eligibility requirements, but all programs come with the following guidelines:
- You must be a Massachusetts resident. If you are only staying in the state for a short period of time, you may not qualify.
- You must be a U.S. national citizen or fall into one of MassHealth’s approved immigration status segments. If you are undocumented or fall outside of one of these immigration segments, then you may qualify for MassHealth Limited (see below).
Generally, MassHealth Insurance is available to those with low income or who meet other eligibility requirements. Your income is evaluated based upon how it compares with the Federal Poverty Level (FPL). This amount may change every year by the federal government as required by a family, for shelter, food, transportation, and other necessities and is based on family size. For example, in 2013, the household annual FPL of one person was kept at $11,490, while for 4, it was $23,550.
Programs and coverage within MassHealth
Below are the programs within MassHealth Insurance.
MassHealth Standard:
This program offers comprehensive health care coverage, which also includes long term care. It is available to parents with children under the age of 19, the disabled, elderly, pregnant women or those requiring cervical cancer or breast treatment. This insurance is eligible for adult foster care services, which offers caregivers a monthly payment for taking care of someone at home.
Coverage includes:
- Few outpatient & inpatient hospital services
- Medical services like x-rays, hearing aids, glasses & lab tests
- Substance abuse including mental health services
- Screening for children of 21 years & under, including vision, dental, medical, mental health, developmental screens, hearing, shots & substance abuse.
- Transportation services
- Long-term care services (at home or long-term care facility)
- Adult Foster Care
- Services offered to quit smoking
MassHealth CommonHealth:
Services covered under this program are similar to that of MassHealth Standard. It is meant for those who are disabled and cannot qualify for MassHealth Standard, since they fall into a high income bracket. This insurance is eligible for adult foster care services, which offers caregivers a monthly payment for taking care of someone at home.
Coverage includes:
- Few outpatient & inpatient hospital services
- Medical services like x-rays, hearing aids, glasses & lab tests
- Substance abuse including mental health services
- Screening for children of 21 years & under, including vision, dental, medical, mental health, developmental screens, hearing, shots & substance abuse.
- Transportation services
- Long-term care services (at home or long-term care facility)
- Adult Foster Care
- Services offered to quit smoking
MassHealth Family Assistance:
This program provides coverage to children under the age of 19, adults under 65 years and HIV positive individuals who are not eligible for CommonHealth or Standard programs. Insured working adults meeting specified criteria will be able to receive assistance with 19 health insurance premiums. This criteria includes:
- An adult is eligible if the Modified Adjusted Gross Income (MAGI) of the MassHealth MAGI household is at or below 300% of the federal poverty level and is a nonqualified PRUCOL, and does not have access to employer-sponsored insurance that is considered affordable (meets the Minimum Essential Coverage (MEC) requirements under section 1401 of the Patient Protection and Affordable Care Act (ACA)).
- An adult who is HIV positive is eligible if the Modified Adjusted Gross Income (MAGI) of the MassHealth MAGI household is greater than 133%, but at or below 200% of the federal poverty level and is a U.S. citizen/national or a qualified noncitizen.
- A disabled adult is eligible if the household income is at or below 100% of the federal poverty level and is a qualified noncitizen barred, a nonqualified individual lawfully present, or a nonqualified PRUCOL.
- A certain adult is eligible who gets Emergency Aid to the Elderly, Disabled and Children (EAEDC).
Coverage includes:
- Few inpatient & outpatient hospital services
- Medical services including x-rays, lab tests, hearing aids and glasses
- Substance abuse & mental health services
- Screening for children below 21 years including vision, medical, dental, mental health, hearing, developmental screens, shots and substance abuse
- Provide assistance to quit smoking
- Home health services
- Emergency related ambulance services
MassHealth Prenatal:
This program is offered to pregnant women for routine office visits. It will cover prenatal appointments and exams for about 60 days. Labor & delivery are not included.
MassHealth Limited:
This program offers non-citizens with emergency health services. It also covers those undocumented individuals with immigration status denying them enrollment from other MassHealth Insurance of Massachusetts.
With so many programs individuals may find the application process to be confusing. For more information please feel free to contact MassHealth at 800-841-2900 or apply on their website. If you qualify for MassHealth Insurance and would like more information benefits through Mass Care Link and our adult foster care services, please contact us.