Medicaid Eligibility in Massachusetts

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“What are the requirements for Medicaid in Massachusetts?” is a common question asked by potential beneficiaries. In order to learn how to qualify for Medicaid, residents must first understand who is eligible for Medicaid. In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are united to create one program called MassHealth. Massachusetts Medicaid provides comprehensive and inclusive health care coverage for low-income families and individuals. MassHealth benefits offer those who meet Medicaid qualifications assistance by paying part or all of the eligible beneficiaries’ health-insurance premiums. MassHealth coverage can provide assistance for a wide array of needs. To learn more about the Medicaid eligibility requirements in MA, continue to the sections below.

What are the requirements for Medicaid in Massachusetts?

Those curious on how to receive Medicaid benefits in Massachusetts must review the following Medicaid eligibility requirements carefully. In order to be a candidate for the program, first and foremost, an individual must be a resident of the state of Massachusetts. The state considers an individual a resident if he or she lives in Massachusetts or intends to reside in Massachusetts, once how to apply for Medicaid is understood and successfully executed.

Typically, candidates who qualify for Medicaid in Massachusetts are low-income households. Candidates must also be U.S. nationals, citizens or qualified noncitizens in need of health care insurance assistance. If the state is unable to verify an individual’s status, officials will request mandatory documentation to be presented as part of the process of determining that he or she meets all the Medicaid eligibility requirements.

You may be qualified for different types of coverage under MassHealth’s health care program if you are:

  • Younger than 19 years of age.
  • An adult caretaker relative living with children younger than 19 years of age (must be related by blood, adoption or marriage).
  • A spouse or a former spouse of one of those relatives, who is the primary caretaker of any children when neither parent is living in the home.
  • A parent living with children younger than 19 years of age.
  • HIV-positive.
  • A young person between 19 or 20 years of age.
  • An adult that is 21 years of age through 64 years of age.
  • A breast or cervical cancer patient.

Residents 65 years of age and over can receive different types of coverage based on special Medicaid benefits eligibility criteria. Coverage will be determined based on a candidate being:

  • 65 years of age or older and in need of personal care attendant services in order to continue living in the home.
  • In or on a waiting list to move into a long-term-care facility.
  • Living at home, but not in need of long-term care.
  • Living at home and in need of long-term services and support under a Home-and-Community-Based waiver.

To learn more about who is eligible for Medicaid, download our free guide.

What are the income requirements for Medicaid in Massachusetts?

Understanding the MassHealth income requirements is the easiest way to ensure you don’t miss out on benefits, especially if you do not fall under one of the specialized categories of patients listed in the above section. In order to determine a candidate’s Medicaid benefits eligibility, MassHealth will consider a candidate’s Modified Adjusted Gross Income (MAGI) and decide if he or she is eligible to receive benefits and who is living in the household. MAGI is a budget-based system that is used to calculate a person’s household size and income, using federal income tax rules and an applicant’s family size to determine certification for Medicaid benefits. The MAGI Medicaid program was instated in 2014, as part of the Affordable Care Act (ACA). The Medicaid eligibility requirements were considered too narrow for many states, so MAGI for Medicaid was adapted to help provide a more comprehensive health care safety net. MAGI especially helps serve single childless adults, married childless couples, children under 19 years of age and families with children that are under 19 years of age. All MAGI guidelines when determining a candidate are based on gross (before taxes) income.

What are the Medicaid application guidelines in Massachusetts?

Those who meet Medicaid eligibility requirements must then apply by mail, online, by phone or in-person to receive any type of MassHealth benefits. Applying online is the quickest way to find out about qualified benefits. Both the MassHealth and the Massachusetts Health connector utilize the same application to determine if you qualify for MassHealth, the Health Safety Net, Children’s Medical Security Plan, ConnectorCare plans or Advance Premium Tax Credits. Download our complimentary guide to review more details about Medicaid eligibility leading into the application for healthcare benefits.