Health Insurance For Low- Income
The Massachusetts Medicaid program is called MassHealth. It provides healthcare benefits to more than 1 million low- and moderate-income Massachusetts children, families, seniors, and people with disabilities. With the introduction of Obamacare (the Affordable Care Act), Massachusetts opted to expand their Medicaid programs in 2014. If you were denied Medicaid coverage in Massachusetts previous to this expansion, you may now qualify.
Massachusetts Medicaid Plan Options
MassHealth provides healthcare benefits to low-income and moderate-income Massachusetts children, families, seniors, and people with disabilities. MassHealth pays for healthcare services including doctor visits, hospital stays, rehabilitation and therapy services, and behavioral health and substance abuse services. Through the application process, MassHealth will determine the coverage type that the enrollee will receive to meet their health care needs. Eligibility depends on income, citizenship or immigration status, age, and other special circumstances.
MassHealth Standard or MassHealth Limited is for residents of Massachusetts that fall into one of the following groups:
- Younger than age 20
- Parents with a dependent under 19
- Under age 65 with breast or cervical cancer, HIV positive, or disabled
*Program assignment is dependent on income level
MassHealth CommonHealth is for residents of Massachusetts that fall into one of the following groups:
- Disabled child younger than age 20
- Disabled adult aged 21 or older who is employed full time
MassHealth CarePlus is for residents of Massachusetts between ages 21 - 64 that is not eligible for MassHealth Standard.
MassHealth Family Assistance is for residents of Massachusetts that are not eligible for MassHealth Standard due to income but may be eligible to pay a premium and utilize MassHealth coverage.
MassHealth Small Business Employee Premium Assistance offers premium assistance to uninsured adults with income between 133% and 300% of the Federal Poverty Level that work for small employers and are ineligible for any other MassHealth coverage type.
The following programs are offered through MASSHealth:
Special Kids/Special Care Pilot Program
The Department of Children and Families (DCF) and MassHealth cosponsor a program to enroll foster children with special healthcare needs into a Neighborhood Health Plan (NHP) contracted by MassHealth. Through its network of providers, NHP arranges for a full range of medical services to be delivered in the child's foster home when medically necessary. The goal is to make managing complex medical needs easier on foster families.
Text4baby sends free text messages to pregnant women and new mothers with useful tips about having a healthy pregnancy and a healthy baby.
The MassHealth Wellness Program encourages members to take actions to proactively prevent disease and illness in their lives.
Program of All-inclusive Care for the Elderly (PACE)
The Program of All-inclusive Care for the Elderly (PACE) is a care model administered by MassHealth for acute and long-term care individuals age 55 and older that meet state specific criteria for nursing home care placement. The goal of PACE is to maximize the participant’s autonomy and ability to reside in their community, while receiving quality care at lower cost relative to the Medicare, Medicaid and traditional private pay programs.
Additional Massachusetts Medicare Programs
Outside of MassHealth, there are other programs or coverage options available:
Children’s Medical Security Plan (CMSP)
The Children's Medical Security Plan (CMSP) is a program that provides uninsured children and adolescents that do not qualify for MassHealth with primary and preventive medical and dental coverage.
One Care: MassHealth plus Medicare
With One Care, MassHealth and Medicare join forces to offer plans in Massachusetts as an option for people with disabilities to receive a full set of services that would normally require Medicaid and Medicare coverage. The benefit is simplifying coverage so there is only one plan and one person to coordinate care.
Senior Care Options (SCO)
Senior Care Options (SCO) is a comprehensive health plan that delivers all services normally paid through Medicare and MassHealth through a senior care organization. As a result, the member receives quality health care by combining health services with social support services. There are no copays for members enrolled in SCO, which is what differentiates SCO from One Care.
Massachusetts Waiver Programs
The Massachusetts Rehabilitation Commission, MassHealth, and UMass Medical School offer two home and community-based services waivers to assist Medicaid enrollees with acquired brain injury (ABI) have the ability to move to a community-based facility. The two waivers are:
ABI Waiver with Residential Habilitation (ABI-RH) program is for individuals who need supervision and staffing 24 hours a day, seven days a week in a provider-operated residence
ABI Waiver with No Residential Habilitation (ABI-N) program is for individuals that can move to their own home or apartment or to the home of someone else with the appropriate guidance.
Massachusetts Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following groups qualify for Massachusetts Medicaid:
- Children 0 - 12 months with a household income less than 200% of the Federal Poverty Limit (FPL);
- Children 1 - 18 years with a household income less than 150% of the FPL;
- Pregnant women with a household income less than 200% of the FPL;
- Adults with a household income less than 133% of the FPL.
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in Massachusetts, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of Massachusetts' Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such tax credits are only available for people who are not eligible for other plans.
- What is MassHealth?
MassHealth provides healthcare benefits to low-income and moderate-income Massachusetts children, families, seniors, and people with disabilities. MassHealth offers benefits directly, or by paying part or all of your other health insurance premiums. As part of the Commonwealth