MassHealth Family Assistance
NOTE: Glossary words are highlighted. Click on any glossary word to see its definition.
What is Family Assistance?
MassHealth Family Assistance is 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. Family Assistance also provides premium assistance for certain employed adults with private health insurance through qualified employers.
Am I eligible?
MassHealth Family Assistance has two forms:
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Premium assistance, where MassHealth pays part of your private health insurance premium
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Direct medical benefits coverage, where you receive MassHealth benefits by enrolling in a health plan
Premium assistance is for people who are not eligible for MassHealth Standard or CommonHealth and are in the following categories:
- children under 19 who have (or have access to) approved employer-sponsored health insurance
- certain employed adults age 19 to 64 who have (or have access to) approved health insurance from a qualified employer
- people under 65 who are HIV-positive and have (or have access to) approved private health insurance
Direct medical benefits coverage is for people who are not eligible for MassHealth Standard or CommonHealth and are in the following categories:
- children under 19 who do not have access to health insurance
- people under 65 who are HIV-positive and do not have private health insurance that meets MassHealth standards.
For more information about MassHealth eligibility, see Am I Eligible?
You can use the MassHealth Eligibility Check to see if you are likely to qualify for MassHealth benefits.
What is a qualified employer?
A qualified employer is an employer (or self-employed person) who:
- Has no more than 50 full-time employees
- Contributes at least ½ the cost of the health-insurance premium
- Participates in the Insurance Partnership
- Provides health insurance basic benefits that are approved by MassHealth.
What are the income and asset limits?
Income limits for MassHealth Family Assistance are based on percentages of the Federal Poverty Guidelines (FPG). For dollar amounts, see Financial Eligibility Requirements: What are the income limits?
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For children under 19 years of age, family gross income must be greater than 150% of the Federal Poverty Guidelines, but less than 300% (200% for noncitizens with special status). There is no asset limit.
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For employed adults ages 19 to 64, family gross income must be less than or equal to 300% of the FPG with no asset limit.
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For people under 65 who are HIV-positive, family gross income must be less than or equal to 200% of the FPG with no asset limit.
What benefits will I get?
If you qualify for premium assistance, MassHealth will pay part of your private health insurance premiums. You will either get a monthly check sent to you, or your employer will reduce your payroll deduction for health insurance. You will get whatever health care benefits your private health insurance offers. In addition, children under age 19 will get MassHealth dental benefits. (Your private insurance must meet the basic standards of MassHealth.)
If you do not have private health insurance, you will get direct coverage by enrolling in a health plan through MassHealth. You will get comprehensive coverage that includes most of the benefits of MassHealth Standard. See MassHealth Standard. However, you will not be covered for:
- long-term care in a medical facility (nursing home, hospital, etc.)
- transportation (except for medically necessary ambulance and wheelchair van service)
- adult day health services and adult foster care
- personal care and private nurse services
How do I apply?
You must file a MassHealth application, called the Medical Benefit Request (MBR). For application information, see How Do I Apply?
How much does it cost?
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HIV-positive individuals receiving MassHealth Family Assistance have to pay a monthly premium if family income is greater than 150% of the Federal Poverty Guidelines.
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For families with children under 19, monthly fees are based on a sliding scale that depends on income. Monthly fees range from $12 per child with a $36 family maximum at the low end of the income scale, to $28 per child with an $84 family maximum at the high end of the scale.
Note: Monthly premiums are waived for children whose parents pay premiums for Commonwealth Care.
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For employed adults without children, the monthly payment ranges from $27 to $80 per person, depending on income.
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For income limit dollar amounts, see What are the income limits?
You may also have to pay co-payments, depending on your coverage.
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