Table A. MassHealth State Plan Base Populations (continued)* Funding Stream Comments Medicaid Federal Poverty Expenditure and MassHealth Mandatory and Level (FPL) Eligibility Group Demonstration Optional Plan and/or Other (EG) Reporting Program Groups Qualifying (Categorical Criteria Eligibility) XIX if insured at the time of application XXI if 1902(r)(2) Medicaid Expansion Ages 1 - 18: uninsured Children II 133.1 through Standard at the time of Children 150% application Funded through 1902(r)(2) XXI XIX if title XXI is RO exhausted Medicaid Expansion Ages 19 and 20: Children II (effective Title XIX 1902(r)(2) Standard 133.1 through January 1, 2014) Children 150% CHIP Unborn Children 0 through 200% Title XXI n/a Standard Pregnant women 0 through 185% Title XIX Base Families Standard Parents and caretaker relatives ages 19 through 64 eligible 0 through 133% Title XIX Base Families Standard section 1931 and
Table A. MassHealth State Plan Base Populations (continued)* Medicaid Mandatory and Optional Plan Groups (Categorical Eligibility) Federal Poverty Level (FPL) and/or Other Qualifying Criteria Funding Stream Expenditure and Eligibility Group (EG) Reporting MassHealth Demonstration Program Comments Medicaid Expansion Children II Ages 1 - 18: 133.1 through 150% XIX if insured at the time of application XXI if uninsured at the time of application Funded through XIX if title XXI is exhausted 1902(r)(2) Children 1902(r)(2) XXI RO Standard Medicaid Expansion Children II (effective January 1, 2014) Ages 19 and 20: 133.1 through 150% Title XIX 1902(r)(2) Children Standard CHIP Unborn Children 0 through 200% Title XXI n/a Standard Pregnant women 0 through 185% Title XIX Base Families Standard Parents and caretaker relatives ages 19 through 64 eligible section 1931 and 0 through 133% Title XIX Base Families Standard
1115%20MassHealth%20Demonstration%20STC%206-27-18.docx