MassHealth coverage types* Population (today) Covered Services Notes ~1.2M members Emergency services only Kids <150% FPL Pregnant women and infants Under reform proposal, non- <200% FPL disabled parents/caretakers Parents/Caretakers <133% FPL <100% FPL will move to Disabled and medically Full MassHealth benefit, CarePlus, and frail adults** <133% FPL including medical, dental, parents/caretakers 100-133% behavioral health, long- Seniors <100% FPL FPL will move to ConnectorCare term services and supports, and ~320K members medical population of “ACA expansion” transportation childless, non-disabled adults 21- 64 Under pending 1115 waiver request, CarePlus will not cover non-emergency medical ~185K members transportation (except for Same benefits as Standard substance use treatment) Lawfully present adults <133% except does not cover FPL LTSS because population Lawfully present individuals Individuals not lawfully present is not disabled are also eligible for who would otherwise qualify for ConnectorCare Standard or CarePlus but for sharing ~25K members Premium assistance is mandatory Members with employer Commercial/primary for adults when cost effective for or student health insurance benefits + MassHealth insurance MassHealth “wrap” MassHealth assists with (e.g., dental services) premiums and cost *Not comprehensive (e.g., does not include Family Assistance for kids up to 300% FPL, CommonHealth for higher income disabled kids and adults)
MassHealth coverage types* Population (today) Covered Services Notes ~1.2M members Kids <150% FPL Pregnant women and infants <200% FPL Parents/Caretakers <133% FPL Disabled and medically frail adults** <133% FPL Seniors <100% FPL ~320K members “ACA expansion” population of childless, non-disabled adults 21- 64 ~185K members Lawfully present adults <133% FPL Individuals not lawfully present who would otherwise qualify for Standard or CarePlus but for Full MassHealth benefit, including medical, dental, behavioral health, long- term services and supports, and medical transportation Same benefits as Standard except does not cover LTSS because population is not disabled Emergency services only Under reform proposal, non- disabled parents/caretakers <100% FPL will move to CarePlus, and parents/caretakers 100-133% FPL will move to ConnectorCare Under pending 1115 waiver request, CarePlus will not cover non-emergency medical transportation (except for substance use treatment) Lawfully present individuals are also eligible for ConnectorCare ~25K members Members with employer or student health insurance MassHealth assists with premiums and cost sharing Commercial/primary insurance benefits + MassHealth “wrap” (e.g., dental services) Premium assistance is mandatory for adults when cost effective for MassHealth *Not comprehensive (e.g., does not include Family Assistance for kids up to 300% FPL, CommonHealth for higher income disabled kids and adults)