Sections:

• Notes for all noncitizens
• When are noncitizen adults eligible for MassHealth
• Eligibility for Immigrant CHILDREN & PREGNANCY/POST-PARTUM PERIOD
• Premium Assistance for certain mixed-immigration families
• Benefits for certain Immigrant EAEDC recipients
• Note on Public Charge
• More Information on ACA

Notes for all noncitizens

Applicants must show proof of immigration status within 60 days to qualify for all MassHealth coverage types except MassHealth Limited.

Keep in mind that immigrants, like everyone, also need to meet other eligibility criteria; when we say a type of immigrant status is eligible for a certain type of MassHealth that means IF the individual also meets financial requirements.

When are non-citizen adults eligible for MassHealth?

Citizens are eligible for all MassHealth coverage types.

Undocumented immigrants are only eligible for MassHealth Limited (emergency services only), Health Safety Net, and, as of 1/1/14 (as part of Affordable Care Act implementation), pregnant women with income at or less than 200% FPL are eligible for MassHealth Standard. For these women, eligibility for post-partum care continues for 60 days following the termination of the pregnancy plus an additional period extending to the end of the month in which the 60-day period ends.).

Undocumented immigrants can apply for MassHealth Limited without fear of deportation. MassHealth will not report immigration status to US Citizenship and Immigration Services (USCIS).

Other noncitizens- Some noncitizens known to the US Citizenship and Immigration Services (USCIS) are eligible for more comprehensive coverage than MassHealth Limited, depending on many factors, including their immigration status, the date they entered the country, the date of obtaining status, and their age. (NOTE: different rules apply to immigrant children.)

1. The following are eligible for full MassHealth regardless of when they entered the U.S. or how long they have had their status:

• Persons granted asylum
• Refugees
• Persons whose deportation has been withheld
• Cuban/Haitian entrants (a specific status - not all from Cuba or Haiti), pending asylum app may qualify
• American Indians born outside the U.S.
• Victims of severe forms of trafficking
• Certain Iraqi and Afghan Special Immigrants
  (“Revisions to Regulations about Qualified Aliens and Aliens with Special Status”, MassHealth Eligibility Letter 181, August 1, 2008; effective retroactively to December 26, 2007).
• Special note on Residents of Micronesia, the Marshall Islands, and Palau:
  • The three Pacific Island sovereign states of Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau are known as Freely Associated States (FAS). FAS citizens are not citizens or nationals of the United States. However, FAS citizens admitted to the United States under the Compacts (known as COFA migrants) may reside, work, and study in the United States for an unlimited length of time. As of December 27, 2020, COFA migrants are now eligible to receive full MassHealth coverage as Qualified Non-Citizens (QLP). Under this new QLP status, COFA migrants will not be subject to the five-year bar if they maintain COFA migrant status. If a COFA migrant adjusts to legal permanent resident status (LPR) they may be subject to the five-year bar. 130 CMR 504.003(A)(1)12 and 130 CMR 518.003(A)(1)12 have been revised to address these updates. MassHealth Eligiblity Letter 240, 8/19/22.

2. Certain immigrants are eligible for full MassHealth under the following conditions. Legal Permanent Residents (LPRs), conditional entrants, or people granted parole for at least one year, when:
   • They entered before August 22, 1996.
     They physically entered the U.S., regardless of status at the time of entry, before August 22, 1996 and have lived in the U.S. continuously (except for short visits outside the U.S.) from the most recent date of entry prior to August 22, 1996 until getting parole, conditional entry, or LPR status.
     • This rule applies even if they entered without inspection or stayed after a visitor's visa expired.
     • To benefit from this rule, applicants should put their actual (pre 08/22/1996) U.S. entry date on the application form even if the entry was not "legal."
     Example.

   • They had LPR or parole status for 5 or more years.
     They have had LPR or parole status for 5 years or more. The 5 years begin with the date status was awarded even if the U.S. entry date was later.
     Example.
   • They had a prior exempt status.
     They had one of the statuses listed above as exempt from the 5-year bar prior to obtaining LPR status. Threfore it is very important to ask what status the individual had before becoming an LPR.
     Example.
3. Immigrants who are veterans, domestic violence victims and "grandfathered" individuals are eligible under these circumstances:
   • The following veterans, their spouses, unremarried widows, or unmarried dependent children are eligible for full MassHealth:
     • U.S. veterans with an honorable discharge;
     • Filipino veterans who fought under U.S. command in WWII;
     • Hmong and Highland Lao veterans who are legal permanent residents and fought under U.S. command during the Vietnam war; or
     • Persons on active duty in the U.S. armed forces
     
     Example.

   • The following domestic violence victims who meet all categorical and financial eligibility criteria are eligible for MassHealth:
     • Immigrants or their unmarried dependent children who have been subjected to battery or extreme cruelty by their spouse, parent, sponsor, or a member of the family group, and
     • who no longer live with the batterer.
     
     Example.

   • The following "grandfathered" individuals who meet all categorical and financial eligibility criteria, are eligible for MassHealth regardless of immigration status:
   • Individuals receiving medical assistance or CommonHealth on June 30, 1997;
   • Individuals with an application for long-term care pending on July 1, 1997; or
   • Individuals residing in a nursing facility as of June 30, 1997.
   
   Example.

    

MassHealth eligibility for Immigrant CHILDREN & during PREGNANCY AND POST-PARTUM

• Insurance options for immigrant children -Easy reference grid from Partners office of Public Payer Policy and Operations (2009).

  Note: this was written prior to Affordable Care Act implementation. Families with any LEGAL status (except for DACA which is treated as undocumented for health care coverage purposes) and income below 300% FPL can purchase health plans through the Connector with State and Federal Subsidies. Those with income between 300 and 400% FPL can purchase plans through the Connector with a federal subsidy.

Full MassHealth is available to children who are special status aliens as described below:

• All children who are legal permanent residents or have parole status regardless of entry date or the date of obtaining status.
• Children who are permanently residing in the U.S. under color of law (PRUCOL). This includes most situations in which a child is living in the U.S. with the knowledge of immigration officials. The following are some examples of children who are PRUCOL:
  • Temporary Protected Status granted,
  • Application filed for adjustment of status,
  • Application filed for asylum, or
  • Indefinite stay of deportation granted.

• Children in families with gross income under 150% of poverty usually receive MassHealth Standard. (Since the fall of 2009 these children are eligible for federal reimbursement, which allows the state to upgrade them to MassHealth Standard. Previously, special status immigrant children at this income level received MassHealth Family Assistance, or, if the child was disabled, CommonHealth.)

• Legal Immigrant children who have had their green card for less than 5 years depending on income:
  • Children with household income up to 150% FPL have been upgraded (9/09) from MassHealth Family Assistance to MassHealth Standard.
  • Children with household income between 150%-200% FPL get MassHealth Family Assistance.
  • Children with household income between 200%-300% FPL have been (9/09) upgraded from Children's Medical Security Plan (CMSP) to MassHealth Family Assistance. MassHealth Family Assistance has more comprehensive benefits than CMSP, such as inpatient and outpatient hospital services, ED visits, dental and pharmacy benefits.
  • Children with household income above 300% FPL are eligible for Children's Medical Security Plan (CMSP).

• During Pregnancy and Post-Partum

  Pregnant people with any immigration status, including undocumented, with income at or below 200% FPL can get MassHealth Standard during their pregnancy, and postpartum care, as of summer 2022, for one year (https://www.mass.gov/news/masshealths-extended-12-month-postpartum-coverage-approved-by-the-federal-centers-for-medicare-medicaid-services). (Formerly 60 days after the termination of the pregnancy.)

  History: The initial expansion was added in 9/09 for women subject to the 5 year bar and then under Affordable Care Act implementation, as of 1/1/14, it was expanded to those with any immigration status and as noted above, extended from 60 days postpartum to 1 year in 2022.

• Children under age 19 who have MassHealth Premium Assistance

  Children who are in this category and don’t have dental benefits will now get their dental benefits through MassHealth (effective October 2009). These members will also receive MassHealth cards to be used for their dental coverage.

• Children born to MassHealth eligible women (not Connector Care or HSN)

  As you may know, a child born in the U.S. to a MassHealth eligible woman, regardless of the mother's immigration status, is eligible for MassHealth and is exempt from providing citizenship and identity verification for up to one year. Effective 6/15/09, citizenship and identity documentation is no longer required for the infant. Infants will be automatically enrolled into the program for which they are eligible.

• For more detail and background regarding immigrant children and pregnant women, see "States Can Now Offer Legal Immigrant Kids & Pregnant Women Health Coverage During 5-Year Bar"- MGH Community News, September 2009.

MassHealth Premium Assistance for certain mixed-immigration families:

Some employees may be able to get health insurance through their employers, but the premiums are too costly. MassHealth has several "Premium Assistance" programs that pay most of the employee's share of the premium for health insurance coverage. If any member of the family is eligible for one of these MassHealth Premium Assistance programs to pay for family coverage, the entire family will benefit, regardless of the immigration status of other family members.

Premium Assistance for MassHealth Standard, CommonHealth, or Family Assistance:

• At least one member of the family must be a citizen or an immigrant who is eligible for MassHealth Standard, CommonHealth, or Family Assistance.
• The family must have access to group health insurance that will cover the eligible family members, and
• MassHealth must determine that it is "cost effective" to assist with the premium costs of family coverage under the group health insurance policy compared to the costs of providing only direct coverage to the eligible family member.
• Depending on income, the family may have to pay a share of the premium.

Example.