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MassHealth
- AN OVERVIEW -
For more information, click on the questions below:
MassHealth is a public health insurance program for eligible low and medium-income residents of Massachusetts. MassHealth is the name used in Massachusetts for Medicaid and the Children's Health Insurance Program (CHIP), combined in one program.
To be eligible for MassHealth, you must be a low to medium-income resident of Massachusetts and meet certain general and financial eligibility requirements.
The MassHealth Eligibility Check is an easy way for you to find out if you are likely to qualify for MassHealth benefits, by answering questions online about your family, your living situation, your job status, and your income. You will see the results of the eligibility check right away, on your computer screen.
MassHealth pays for all or some of a member’s health insurance and health care services. Services and costs vary depending on your type of coverage.
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The MassHealth Dental Program provides dental benefits for MassHealth members. Dental benefits include checkups, cleanings, fillings, extractions, braces, dentures, and other necessary dental services.
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MassHealth pays home health agencies to provide nursing care; home health aide care; and occupational, physical, and speech/language therapy to eligible MassHealth members. Home health care services must be medically necessary and part of a doctor’s plan of care.
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MassHealth behavioral health services include assessments and treatments for a wide range of mental and emotional disorders as well as substance abuse treatment services. The Children's Behavioral Health Initiative provides additional services for children and youth under 21.
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The Personal Care Attendant Program (PCA) helps people with long-term disabilities live independently at home. MassHealth provides funds so that eligible Standard and CommonHealth members can hire personal care attendants to assist them with activities of daily living.
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MassHealth members who need non-emergency transportation to and from medical appointments may be eligible for free transportation services.
To apply for MassHealth, you should call the MassHealth Enrollment Center at 1-888-665-9993 (TTY: 1-888-665-9997) to request an application. You can also download an application from MassHealth Applications and Member Forms on the MassHealth web site, or visit a community health center.
Once you have been approved for MassHealth, you will receive an enrollment package explaining how to choose a health plan and a primary care doctor. You will also receive your MassHealth card which you must show whenever you need medical care.
MassHealth members who want to enroll in an MCO managed care plan can choose from four plans: BMC HealthNet, Fallon Community Health Plan, Neighborhood Health Plan, and Network Health. All of the MCOs offer all MassHealth benefits, plus extras.
You can call MassHealth Customer Service at 1-800-841-2900 (TTY: 1-800-497-4648) to find a doctor, dentist, or other health care provider in your area. Most MassHealth MCOs have online provider search tools.
MassHealth includes several coverage types with different rules for each coverage. The coverage types are:
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MassHealth Standard: comprehensive health insurance, including long-term-care, for low-income Massachusetts residents including eligible parents with children under 19 years of age, pregnant women, children up to 19 years of age, the elderly, and disabled individuals.
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CommonHealth: complete coverage similar to MassHealth Standard, for eligible disabled adults and disabled children through age 18 who cannot get MassHealth Standard because their incomes are too high.
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MassHealth Family Assistance: health insurance with most of the services of MassHealth Standard, for children under 19 and people with HIV who are not eligible for MassHealth Standard or CommonHealth; also health insurance premium assistance for certain employed adults.
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MassHealth Basic: a full range of health care benefits or premium assistance for EAEDC recipients and low-income Department of Mental Health clients who are long-term unemployed. (Note: Due to state budget cuts, immigrants with special status are no longer eligible for MassHealth Basic.)
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MassHealth Limited: emergency medical coverage for noncitizens whose immigration status makes them ineligible for other MassHealth programs.
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Medicare Buy-In programs: programs that pay all or part of Medicare health insurance expenses for eligible low-income Medicare recipients.
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MassHealth Prenatal: short-term outpatient prenatal care (does not include labor and delivery) for low-income pregnant women.
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MassHealth Essential: a wide range of health care benefits for the long-term unemployed who do not meet the eligibility requirements for MassHealth Basic. Coverage is similar to MassHealth Basic, but more limited.
MassHealth has a number of special programs for people with certain medical conditions or in certain target groups. These programs have separate eligibility requirements and may offer benefits in addition to MassHealth insurance coverage.
Links to other web sites with information about MassHealth.
The MassHealth section was last updated on 10/20/09
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