Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth


		MassHealth
		Eligibility Letter 170
		November 15, 2007

TO:	MassHealth Staff

FROM:	Tom Dehner, Medicaid Director

RE:	Revision to Time Standards for an Eligibility Review

MassHealth is revising its regulations about the time standards for review of a 
member’s eligibility. The time standard to return a review form has been changed 
from 60 days to 45 days. Failure to return a written update within 45 days will 
result in the termination of a member’s eligibility.

These regulations are effective December 1, 2007.


	MANUAL UPKEEP

Insert	Remove	Trans. By

502.007	502.007	E.L. 169


130 CMR:  DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 170

Rev. 12/01/07

	MASSHEALTH
	THE REQUEST FOR BENEFITS

Chapter 502
Page 502.007

(3)  the member is no longer eligible for MassHealth.

(C)  The MassHealth agency does not notify the member if there is no change in 
the member’s coverage type, premium payment, or premium assistance payment.

(D)  If the member’s coverage type changes, the start date for the new coverage 
type is determined as follows.

(1)  If the new coverage type provides more comprehensive benefits to the 
member, coverage is effective as of the date of the written notice with the 
following exceptions.

(a)  Coverage for the purchase of medical benefits under Basic is effective upon 
the member’s enrollment with a MassHealth managed care provider.

(b)	Coverage for the purchase of medical benefits under Essential is effective 
upon the member’s enrollment in the Primary Care Clinician (PCC) Plan. 
MassHealth Essential members who are aliens with special status are afforded 
eligibility under MassHealth Limited pursuant to 130 CMR 505.007(E).

(c)  Coverage for premium assistance under Basic and Essential is effective in 
the calendar month following the date of the written notice. MassHealth 
Essential members receiving premium assistance who are aliens with special 
status are afforded eligibility under MassHealth Limited pursuant to 130 CMR 
505.007(E).

(d)  Premium assistance payments under Family Assistance begin in the month of 
the MassHealth agency’s eligibility determination, or in the month the insurance 
deduction begins, whichever is later.

(2)  If the new coverage type provides less comprehensive benefits to the 
member, coverage is effective subsequent to the member’s receipt of a timely 
written notice in accordance with 130 CMR 610.015.

(E)  If the member fails to provide a written update of his or her circumstances 
within 45 days of the MassHealth agency’s request, MassHealth coverage is 
terminated, except as provided in 130 CMR 502.007(G). If the member subsequently 
submits a written update, the MassHealth agency determines his or her 
eligibility as of the date the written update is received. If the applicant is 
determined eligible, the medical coverage date is established in accordance with 
the rules in 130 CMR 502.006.

(F)  If the member fails to provide verification of information within 60 days 
of the MassHealth agency’s request, MassHealth coverage is terminated. 

(1)  Except as provided at 130 CMR 501.003(E), if required verifications are 
received within one year of receipt of the previous MBR or written update on a 
prescribed form, coverage is reinstated 10 days before receipt of the 
verifications unless the member is determined eligible for the purchase of 
medical benefits under MassHealth Basic or Essential, or premium assistance 
under Basic, Essential, or Family Assistance. For those members, the medical 
coverage date is established in accordance with the rules in 130 CMR 502.006. 
Coverage under Essential is also subject to the funding restrictions described 
at 130 CMR 505.007.