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Learn About Requirements for Medicaid in Massachusetts

UPDATE: For the year 2020, Medicaid plans will follow the same requirements and application methods.

Medicaid, Medicare and Children Health Insurance Program are examples of functional plans provided to the underserved citizens of Massachusetts. Who is eligible for Medicaid, and what are the requirements for Medicaid in Massachusetts? In order to qualify for Medicaid benefits in MA, potential beneficiaries must first meet the enforced Medicaid requirements.

Medicaid eligibility requirements are specific to the state in which a candidate resides. Therefore, a patient interested in learning how to qualify for Medicaid in Massachusetts should not review information in another state, like Maryland.

Medicaid benefits eligibility is broken down into general requirements for Medicaid and financial requirements. Interested applicants must meet all Medicaid requirements to receive Medicaid benefits.

Who meets the requirements for Medicaid in Massachusetts?

Candidates are eligible for Medicaid so long as they meet the standards set forth by the state of Massachusetts. The major Medicaid eligibility groups in Massachusetts include low-income patients, pregnant women, the elderly, the blind, the disabled and needy families with children.

Medicaid eligibility requirements in Massachusetts apply to certain circumstances beyond the patient groups deemed eligible for Medicaid. Patients can still qualify for Medicaid in Massachusetts if:

  • There are countable resources in addition to income (bank accounts, cars, and homes do not disqualify candidates from Medicaid benefits in Massachusetts).
  • Employed by part-time or full-time work engagement.
  • Current health insurance is held through a different medical program.
  • Aged 19 to 65 and earning a low income.
  • Living as a child with grandparents, stepparents or income-earning siblings.
  • The family belongs to Massachusetts’ Temporary Assistance for Needy Families (TANF) program already.
  • Of childbearing age (women) and in need of birth control and/or family planning services for up to 24 months after Medicaid benefits end.
  • Receiving welfare, followed by reemployment.

Learn more about Medicaid requirements by downloading our comprehensive guide.

What Are the Requirements for Medicaid in Massachusetts?

If you live in Massachusetts the basic requirements for Medicaid are similar to other states. To qualify for Medicaid in MA, an applicant must be a citizen of the state.

Otherwise, legal aliens are eligible for Medicaid too. Non-citizens applicants have to show proof of legal alien status. Candidates must meet all Medicaid eligibility requirements in full in order to advance to the Medicaid application process.

You will need to furnish the Department of Health and Human Services with details of your social security, income levels and family size among other things. Simply put, there are specific financial and non-financial eligibility rules for Medicaid in Massachusetts.

Finally, a candidate must meet Medicaid income requirements to apply successfully for state-sponsored medical assistance. What are the income requirements for Medicaid?

The income requirements for Medicaid are determined by the national Modified Adjusted Gross Income (MAGI) system. This Medicaid eligibility calculator takes into consideration household size, monthly/annual income and the current Federal Poverty Levels (FPL).

What are the Medicaid application guidelines candidates must meet as decided by the MAGI? The following are examples:

  • Households of pregnant women should not exceed 200% of FPL
  • Households with children aged less than 1 year should not exceed 200% of FPL
  • Households with children aged 1-18 years should not exceed 150% of FPL
  • Households of adults should not exceed 133% of FPL

Next, Medicaid qualifications require a candidate to reside lawfully in the state of Massachusetts. Simply put, if an applicant does not live within the MA state borders, he or she cannot qualify for Medicaid.

Most times, a valid driver’s license or a state ID card can prove a potential beneficiary’s residency for Medicaid benefits eligibility purposes. Furthermore, a registered Social Security Number is part of the requirements for Medicaid.

Since Medicaid is also overseen by the federal government, a Social Security Number acts as an identifier when it comes to verifying income eligibility for Medicaid. In addition, Social Security Numbers are used to handle Medicaid benefits in Massachusetts.

Download our helpful guide to learn about the different requirements for Medicaid.

How to Use a Screening Tool

Patients who are still unsure of how to qualify for Medicaid in Massachusetts can receive online assistance. Screen Medicaid eligibility through the Massachusetts online tool, which can be accessed via a home computer with working internet access.

Before engaging with the Medicaid qualifications test, applicants should ensure they meet the system requirements. Otherwise, visit an office for in-person help.

The Medicaid requirements screener asks users to first answer questions about those residing in the home, income and resource estimates, personal details and health-related conditions present, any current benefits being dispensed in the household and more. Answers about Medicaid qualifications are transferred through a secure portal, and remain confidential at all times.

Once the requirements to be eligible for Medicaid are determined, a list of available Medicaid benefits and programs will appear, depending on qualifications. Medicaid-related programs include long-term care (nursing home services, home- and community-based services and the Children’s Community Alternative Disability Program) and basic health care coverage (Medicaid, Massachusetts Healthy Children Program/CHIP, and Qualified Medicare Beneficiary).

In addition to Medicaid benefits, users can view other available programs through the state related to child care assistance, cash assistance, and food stamps. Following the results of the Medicaid eligibility test, beneficiaries will have the option to apply for Medicaid.