Written by a parent, not a doctor. Nothing here is medical advice.

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Massachusetts program

Government health insurance for your child (MassHealth Standard)

Massachusetts’ free health insurance for children under 19 [MassHealth Standard]. It can sit behind your work insurance.

What it is

Massachusetts’ free health insurance for children under 19 [MassHealth Standard]. It can sit behind your work insurance.

MassHealth Standard covers eligible children using their age, household and current income. A disability can open a different eligibility route. Work insurance can stay in place while MassHealth decides which coverage fits.

Eligibility rules
  • Your child must live in Massachusetts and be under 19. The published line is 200% of poverty under one, and 150% at ages 1–18.
  • MassHealth decides your child’s household and current monthly income. Tax-filing rules often apply, with exceptions for children and non-filers. A yearly figure divided by 12 is only an estimate after a pay change.
  • Published monthly limits from March 1, 2026, ages 1–18: 2 people $2,705; 3 $3,415; 4 $4,125; 5 $4,835; 6 $5,545.
  • Under one, the published monthly limits are $4,554 for 3 people and $5,500 for 4.
  • These ordinary age-and-income bands do not settle disability-based Standard or CommonHealth eligibility. MassHealth confirms the current category and income table for your child.
Why look at MassHealth when you have insurance?
  • Your work insurance pays first. For covered care with the required approvals, a clinic enrolled in MassHealth generally cannot charge the work plan’s deductible, coinsurance or copay, even when MassHealth pays nothing extra.
  • There is no child premium for Standard. MassHealth also has routes to nursing at home and appointment rides.
What to check before deciding
  • Ask the financial counselor how both plans handle your child’s treatment, pharmacy and bills.
  • Ask the counselor to check eligible dates, treatment approvals and whether each hospital, clinic and pharmacy accepts MassHealth.
What you get
  • No premium and no child copays for covered hospital care, chemotherapy, clinic visits and medicines.
  • Home nursing and rides can be available through MassHealth.
  • Eligible bills from before the application can be covered.
What the help covers
  • Nursing at home has a separate care assessment. Rides require a clinic request and trip arrangements.
  • The financial counselor can check your oncology team, hospital and pharmacy against the exact MassHealth plan.
  • For covered care with any required authorization, a MassHealth-enrolled clinic must bill your private plan first. It generally cannot charge you that plan’s deductible, coinsurance or copay, even when MassHealth pays nothing extra. Genuinely noncovered services and care outside eligible dates need a separate review. A billing error does not by itself make the charge yours.
If you decide to apply
  1. Ask the hospital financial counselor to go through the MassHealth application with you through the Health Connector or by phone.
  2. Have your child’s identification, Social Security number, Massachusetts address, current pay information and insurance cards ready.
  3. Include earlier hospital bills and ask whether the hospital can open temporary coverage while you wait.

MassHealth, through the state’s combined application: 1-800-841-2900. · Official page ↗

After you ask
  • MassHealth has 45 days to decide, or 90 when a disability must be decided; many decisions come sooner. Answer any missing-information letter quickly.
  • A qualified participating hospital can assess temporary coverage. It normally ends at the end of the following month. A full application filed by then keeps temporary coverage open until MassHealth decides it. The counselor can identify both dates for your child.
  • Coverage can reach up to three calendar months before the application month through 2026, for eligible months. For child applications from January 1, 2027, the period is two months.
  • The federal baseline gives approved children under 19 twelve months of continuous eligibility. MassHealth can confirm the child’s renewal date and whether a longer protection applies.
Good to know

Your work plan is billed first. For covered care at a clinic that accepts MassHealth, you generally cannot be charged the work plan’s deductible or copay.

Other details
  • Family Assistance is the next income band. CommonHealth is a separate disability route when Standard does not fit.
  • Two insurance cards still mean two sets of billing and treatment rules. If a MassHealth plan cuts an existing authorized service, an appeal and a separate request to keep services may both be needed.
  • If a MassHealth plan cuts a service your child already gets, ask within 10 days of the letter for it to continue during the appeal. If you lose, MassHealth can ask you to repay that continued care.
  • Continuation has other conditions, including previously authorized, clinician-ordered treatment and an unexpired authorization. It does not automatically start a newly denied service. Repayment can be sought after a final adverse decision. An advocate can check the actual notices and explain that risk.
  • The coverage notice identifies whether a MassHealth health plan or a fee-for-service arrangement applies. The counselor can check the treatment team and billing rules for that arrangement.

Federal background: Medicaid and using Medicaid with insurance you already have.

Official sources
Ask your social worker

“Could MassHealth reduce our child’s treatment bills alongside any insurance we have? What are the benefits and drawbacks, and could you help with the application if you think it fits?”

Why I’m asking: I want to understand what MassHealth would cover and how it would work with our treatment team.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File the application, report this month’s income and any insurance, name the months with old bills, and pick a plan the oncology group takes.

Your social worker

The oncology social worker or financial counsellor helps you file, asks the hospital to open temporary MassHealth that day, and follows the 45-day decision.

The care team

Nothing for ordinary child MassHealth. Medical records matter for the disability routes, CommonHealth and Kaileigh Mulligan.

Who decides
MassHealth checks income and residency; the MassHealth health plan you pick runs the coverage.
Ask your social worker
“Can you help me file the MassHealth application today and ask the hospital about presumptive eligibility while we wait? Can we list bills from the three months before, and check the hospital and oncology group take the plan?”

How to apply

First step: Apply online at betterhealthconnector.com or call MassHealth at 1-800-841-2900 this week, and ask the hospital counsellor today about temporary MassHealth.

  1. Apply this week and ask the hospital counsellor today about temporary MassHealth while the application is pending.
  2. List the months with bills so the look-back covers the admission.
  3. Pick a MassHealth plan the hospital and the oncology group take.

Official application / program page ↗

Where it starts: Apply online through the Massachusetts Health Connector application, or call MassHealth at 1-800-841-2900. Ask the hospital’s financial counsellor the same day whether it can open temporary MassHealth for your child.

What to gather

  • Child’s birth certificate or ID and Social Security number
  • Massachusetts address
  • This month’s income for each parent in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: MassHealth has 45 days for an ordinary application, 60 where Family Assistance is in play and 90 on disability. A hospital can open temporary coverage the same day.

What a yes looks like

A notice with coverage dates and a choice of MassHealth plan. Check the hospital and the oncology group are in that plan before choosing. Twelve months of continuous coverage follows.

What a no looks like, and the next move

Read whether the no was about income, a document or a category. If it was income, ask for CommonHealth by name and appeal by the date on the notice.

Watch out

  • Massachusetts counts the tax household and this month’s income, not last year’s return or everyone under the roof.
  • Your child can keep private insurance and have MassHealth too. Do not cancel the work plan to apply.
  • If MassHealth says the income is too high, ask in the same application for CommonHealth, the disability route, by name.

Dates that change this

2026-03-01: The income figures come from the MassHealth table effective March 1, 2026. The state says its poverty guidelines update in March; the next date was not published.

2027-01-01: Coverage can reach back up to three calendar months before you apply. For applications made on or after January 1, 2027 federal law narrows that to the second month before; how Massachusetts applies it was not published.

2026-10-01: MassHealth has announced new work and education rules for some adult members and more frequent renewals. Children are not the target of those rules; ask at renewal. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full MassHealth with no premium and no child copays. For four people the line is $5,500 a month under age one and $4,125 at ages 1 to 18; for three people, $4,554 and $3,415.

  • $4,125/month — Ages 1 to 18, household of 4, published monthly line (150% of poverty)
  • $3,415/month — Ages 1 to 18, household of 3, published monthly line
  • $2,705/month — Ages 1 to 18, household of 2, published monthly line
  • $4,835/month — Ages 1 to 18, household of 5, published monthly line
  • $5,545/month — Ages 1 to 18, household of 6, published monthly line
  • $5,500/month — Under age 1, household of 4, published monthly line (200% of poverty)
  • $4,554/month — Under age 1, household of 3, published monthly line
  • $12 — Months of continuous coverage once a child is approved
  • $3 — Calendar months of coverage before the application month
  • $45 — Days MassHealth has to decide an ordinary application

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Care a child under 21 needs, through the child health screening and treatment rule · Continuous skilled nursing at home when it is approved · Rides to appointments on a PT-1 request · Dental and vision

Legal protection: A child can hold private insurance and MassHealth at the same time and shows both cards · Twelve months of continuous coverage for children under 19 since January 1, 2024

What it costs the family: No premium and no copays for a child on Standard.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
MassHealth MAGI household: 200% of poverty under age one, 150% for ages 1 to 18 (130 CMR 505.002); the five-point disregard is a highest-standard test under 130 CMR 506.007
Insurance status condition
none: private insurance coexists and members show both cards
Residency
Massachusetts
Continuous eligibility
12 months for children under 19
Retroactive months
up to 3 calendar months; 2 for applications made on or after 2027-01-01
Processing standard
45 days ordinarily, 60 days where Family Assistance is in play, 90 days on disability (130 CMR 502.005)

Decisions this site cannot make: MassHealth MAGI determination through the online application · Hospital presumptive eligibility by a qualified hospital

Expect friction on: Choosing a MassHealth health plan the oncology team takes; the Tufts Health Together managed care organisation closed on January 1, 2026

The trap: Massachusetts prints no "plus five percent" column. The five-point disregard is a highest-standard test the agency applies when it changes the answer, so a family just over the printed line should still apply. Do not cancel private insurance to apply.

Where I read this

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