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

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Massachusetts program

MassHealth for a disabled child over the income line (CommonHealth)

MassHealth coverage for a child with a disability when Standard does not fit [CommonHealth].

What it is

MassHealth coverage for a child with a disability when Standard does not fit [CommonHealth].

CommonHealth can help when family income is above the Standard line. It can work behind your existing insurance. Your child needs a disability decision, but this route does not require the hospital-level care test used by Kaileigh Mulligan.

Eligibility rules
  • The child route described here is for Massachusetts children under 18 who cannot get Standard.
  • Social Security or Disability Evaluation Services must establish permanent and total disability.
  • The child eligibility rule does not name an income ceiling or require hospital-level care. Premiums rise with income.
  • At 18 CommonHealth re-checks your child under adult rules, on the young adult's own income and disability; it does not end by itself. Ask MassHealth the year before so nothing lapses.
What you get
  • MassHealth coverage alongside a work plan, with a monthly premium based on income.
  • A route to covered treatment and home services after the required care assessments.
What the help covers
  • The treatment team’s letter explains the diagnosis, treatment and activities your child cannot manage.
  • Kaileigh Mulligan is a separate option that leaves out parents’ income but requires a much higher care assessment.
  • The premium rises with income and is lower when your child also has other insurance. Ask MassHealth for the written amount and about hardship relief.
If you decide to apply
  1. Ask the hospital social worker to request CommonHealth on the MassHealth application and a Disability Evaluation Services referral.
  2. Have current income, any Social Security disability decision, and the oncology team’s diagnosis and treatment letter ready.
  3. Ask for the premium quote and a review of both plans before deciding whether to add coverage.

MassHealth, with the disability question decided by Social Security or Disability Evaluation Services: 1-800-841-2900 · Official page ↗

After you ask
  • The application notice and MassHealth can identify the decision deadline for your route. The counselor can ask about missing information, temporary coverage and urgent care while you wait.
  • A written coverage decision and premium quote let you compare the cost with the bills and services covered.
Good to know

Your child does not need an SSI cash award. The state’s Disability Evaluation Services can decide the disability question.

Other details
  • Premiums increased 10% on January 1, 2026. Subsequent annual adjustments start in March 2027.
  • A current disability review considers treatment and functional limitations, including any relapse or transplant. The original diagnosis date alone does not decide whether your child qualifies.
  • Full and supplemental premiums have different calculations. Premium Assistance can reduce a CommonHealth premium before any payment reaches the family. MassHealth can explain which calculation and family cost limits apply.
Official sources
Ask your social worker

“Would CommonHealth help with our child’s bills or home care if Standard does not fit? What would the premium and extra insurance work be, and could you help us request the disability review if it is worthwhile?”

Why I’m asking: I want to understand whether the disability route would offer enough help to justify its premium.

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

Ask for CommonHealth by name, agree to the disability evaluation, and get the premium quote in writing.

Your social worker

The oncology team supplies the records the evaluation needs; the social worker chases the 90-day clock.

The care team

A letter describing the diagnosis, the treatment plan and what the child cannot do now.

Who decides
MassHealth decides the coverage type; Social Security or the state’s Disability Evaluation Services decides the disability question.
Ask your social worker
“We are over the MassHealth income line. Can you help me ask for CommonHealth by name, request a disability evaluation, and find out what the monthly premium would be at our income?”

How to apply

First step: On the MassHealth application, ask for CommonHealth by name and for a disability evaluation, and ask what your monthly premium would be.

  1. Ask for CommonHealth by name on the MassHealth application and request the disability evaluation.
  2. Ask the oncology team for the records the evaluation needs.
  3. Ask MassHealth for the monthly premium at your income before you decide.

Official application / program page ↗

Where it starts: Apply on the MassHealth application and ask in writing for CommonHealth and for a Disability Evaluation Services referral. Ask for your premium quote before you accept.

What to gather

  • The oncology team’s letter about the diagnosis and treatment plan
  • This month’s income for the tax household
  • Any Social Security decision about your child

How long: MassHealth has 90 days to decide an application made on the basis of disability.

What a yes looks like

A notice naming CommonHealth, a plan choice and a monthly premium bill.

What a no looks like, and the next move

A no usually turns on the disability finding. Ask what evidence was missing, ask the oncology team for it, and appeal by the date on the notice.

Watch out

  • You do not need an SSI cash award: the state’s own Disability Evaluation Services can decide disability. Ask for that referral by name.
  • Get the premium quote before you accept, because the premium rises with income and the current price list was not published.
  • Kaileigh Mulligan is a different route: it ignores parents’ money but needs hospital-level care at home.

Dates that change this

2026-01-01: Premium billing rose 10% on January 1, 2026 and the current CommonHealth price table could not be read, so no premium figure is printed. Ask MassHealth for your quote before you decide.

The numbers and the rules

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

What it is worth

MassHealth for a disabled child under 18 whose family is over the Standard line. The reproduced rule lists no income ceiling. A monthly premium applies and its current price was not published.

  • $18 — Upper age in the reproduced under-18 eligibility list
  • $10 — Premium billing increase applied on January 1, 2026

Covers: The MassHealth benefit set, behind a private plan where there is one · Continuous skilled nursing and other home services once MassHealth is in place

Legal protection: Disability can be determined by Social Security or by the state’s Disability Evaluation Services · The reproduced eligibility list sets no income limit and no institutional level-of-care test

What it costs the family: A monthly premium that rises with income. Billing rose 10% on January 1, 2026 and the current table was not published, so the price here is unknown.

The eligibility facts, as published

Age
under 18 in the reproduced list
Age max exclusive
18
Income
no income limit appears in the reproduced eligibility list (130 CMR 505.004); premiums rise with income under 130 CMR 506.011
Disability
permanent and total disability, determined by the Social Security Administration or Disability Evaluation Services
Level of care
none in the reproduced list, unlike Kaileigh Mulligan
Residency
Massachusetts
Processing standard
90 days for an application made on the basis of disability

The trap: You do not need an SSI cash award. Disability can be established either by Social Security or by the state’s Disability Evaluation Services, so ask for that referral when you apply.

Where I read this

← Back to your options