MassHealth is a program that provides health coverage to some low-income Massachusetts residents. It covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities if state and federal guidelines are met. Some immigrants will not be eligible for MassHealth but may be eligible for other programs. Legal residents who are not U.S. citizens may receive coverage for emergency care under a program called MassHealth Limited.
- For certain categories of people, eligibility for MassHealth is based on the amount of your household income.
In Massachusetts you may be eligible for MassHealth if you are an infant, a child, a pregnant woman, the parent of a dependent child, medically needy, elderly or disabled and your family income meets the MassHealth income standards.
Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact your local department of social services for more information.
Low-income persons eligible for MassHealth in Massachusetts*
Category - Income eligibility (as percent of federal poverty level)
Infants 0-1 - 200% (monthly income of $4,292 for family of 3)
Child 1-5 - 150%
Child 6-18 - 150%
Parent - 133%
Pregnant woman - 200%
Disabled Adult - 100%
* Eligibility information was compiled State Health Facts Online, the Henry J. Kaiser Family Foundation and may have changed since this guide was published. Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.
To get an idea of how your income compares to the federal poverty level,* use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2007:
Size of Family Unit Poverty Guideline (annual income)
For larger families add $3,480 for each additional person
So, for example, using this guideline, 200% of the federal poverty level for a family of 3 would be an annual income of $34,342, or a monthly income of $2,862.
* Contact your local department of social services for the most up to date information and for other eligibility requirements that may apply.
- Families who get cash benefits from TANF (also known as Transitional Aid to Families with Dependant Children) should know that when you get a job and your TANF benefits end, you generally can stay on MassHealth for a 12-month-transitional period.
In addition, your children may qualify for MassHealth if your family’s income meets certain income standards.
- Very poor elderly or disabled people who get Supplemental Security Income (SSI) benefits also qualify for MassHealth.
Disabled individuals should now that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage at least for a limited time.
- People who have high medical expenses may also qualify for MassHealth. You may qualify as medically eligible if you are a child, parent of a dependent child, pregnant, elderly, or disabled and have high medical expenses
- Working disabled adults and non-working disabled adults under age 65, and disabled children may qualify for the MassHealth CommonHealth Program. There are no income standards for this program. Those with incomes above 133% of the federal poverty level, however, may have to pay a premium or meet a one-time deductible. The amount of the premium is based on monthly income, family size, and other health insurance you may have.
- Retired or disabled people who have low-incomes and are enrolled in Medicare may also qualify for help through the MassHealth Senior Buy-In program. If your household income is below the poverty level, MassHealth will pay your Medicare monthly premium and your Medicare deductibles and coinsurance. This is called the Qualified Medicare Beneficiary (QMB) program.
If your household income is between 100% and 135% of the federal poverty level, MassHealth will pay for your monthly Medicare premiums only. This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.
- If you receive long term unemployment benefits, are under age 65 and have no health insurance, you may be eligible for the MassHealth Basic program. Your family’s income must not be more than 133% of the federal poverty level.
- If you are a working adult under age 65, have a family income that is not more than 200% of the federal poverty level and are not eligible for MassHealth or MassHealth CommonHealth, you and your family may be eligible for a program that helps you pay for part of your employer-sponsored health plan premium called MassHealth Family Assistance.
- There may be other ways that MassHealth can help. To find out if you or other members of your family qualify for MassHealth, contact the department of social services.
For questions on eligibility or to apply for MassHealth benefits, call the MassHealth Customer Center at (800) 841-2900.