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

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Massachusetts program

MassHealth when medical bills are very high (deductible)

A way to reach MassHealth through medical bills when an eligible disability route uses a spend-down [deductible].

What it is

A way to reach MassHealth through medical bills when an eligible disability route uses a spend-down [deductible].

A deductible can open coverage for part of a period with very large bills, if your child has an eligible MassHealth category. Kaileigh Mulligan includes a child deductible route. MassHealth must identify the category before calculating which income and bills count.

Eligibility rules
  • Where a six-month deductible applies, MassHealth generally calculates six times the monthly countable income above that category’s standard.
  • Only allowable verified liabilities count. Bills paid by another source cannot be used as though the family still owed them. MassHealth checks current unpaid bills and eligible bills paid within the period.
  • High medical bills alone do not establish a child spend-down route. The counselor can ask MassHealth to identify your child’s category, household, income and resource rules before calculating a deductible.
What you get
  • Coverage for the rest of a six-month period after eligible bills meet the deductible.
What the help covers
  • The financial standard depends on the approved category. Kaileigh Mulligan uses a separate child-income standard of $72.80 per month and a $2,000 countable-resource limit. A general household standard should be used only if MassHealth confirms it applies.
  • Coverage begins once enough eligible bills meet the calculated amount and lasts for the remainder of that period.
If you decide to apply
  1. Ask the social worker to have MassHealth identify the child’s eligible route and applicable income standard in writing.
  2. Bring current income and itemized bills, including eligible bills already paid during the period.
  3. Ask the billing counselor how hospital assistance could help with bills used to meet the deductible.

MassHealth: 1-800-841-2900 · Official page ↗

After you ask
  • MassHealth checks the bills against its written calculation. Additional bills can matter as the period continues.
  • Ask MassHealth for the start and end dates of the six-month period in writing.
Good to know

MassHealth does not pay the bills used to meet the deductible. Those costs remain yours unless another source helps.

Other details
  • Health Safety Net and the hospital’s own financial assistance are separate conversations for bills left with the family.

Federal background: medically needy Medicaid and spend-down coverage.

Official sources
Ask your social worker

“Does our child have a route that allows a deductible, and which income standard would MassHealth use? Would the coverage gained justify the bills left to us, and could you help request the calculation?”

Why I’m asking: I do not want to assume that a large bill alone opens MassHealth or that it will pay the deductible bills.

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 the deductible in writing, then send bills in as they arrive.

Your social worker

The hospital billing office prints itemised bills you can submit.

The care team

Records and letters when the application asks for them.

Who decides
MassHealth sets the standard, calculates the deductible and checks the bills.
Ask your social worker
“If we are over the income line, can MassHealth run a deductible for this six-month period, and which income standard would it use for my child?”

How to apply

First step: Ask MassHealth in writing to run a deductible and to tell you the standard and the amount.

  1. Ask MassHealth whether a deductible period applies to your child and which standard it uses.
  2. Keep every bill, including bills paid during the period.
  3. Ask the hospital about financial assistance for the bills the deductible uses up.

Official application / program page ↗

Where it starts: Ask MassHealth to run a deductible and ask which standard it is using for your child. Send the bills in as they come.

What to gather

  • Itemised hospital bills, including ones you have paid in this period
  • This month’s income

How long: The period is six months and can start up to three months before the application month.

What a yes looks like

A notice with the deductible amount and, once bills are accepted, coverage dates for the rest of the period.

What a no looks like, and the next move

Ask whether the no was about the standard used, the bills accepted or the category, and appeal by the date on the notice.

Watch out

  • MassHealth does not pay the bills used to meet the deductible; they stay yours.
  • Ask which standard MassHealth is using for your child before you count on a figure.
  • The period can start up to three months before the month you apply, so say when the bills began.

The numbers and the rules

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

What it is worth

A six-month deductible equal to income above the MassHealth standard times six, met by submitting verified bills. Published monthly standards are $775 for three people, $891 for four and $1,016 for five.

  • $6 — Deductible period
  • $775/month — Published monthly MassHealth Income Standard, household of 3
  • $891/month — Published monthly MassHealth Income Standard, household of 4
  • $1,016/month — Published monthly MassHealth Income Standard, household of 5

Covers: MassHealth coverage for the rest of the six-month period once the deductible is met

Legal protection: The period can begin up to three months before the month of application · An old unpaid bill counts when it is verified by a bill dated inside the period

What it costs the family: The bills used to meet the deductible stay the family’s responsibility.

The eligibility facts, as published

Age
child
Income
countable income above the applicable MassHealth Income Standard; the deductible is the excess times six (130 CMR 520.029-520.030)
Bills
verified bills totalling at least the deductible, unpaid current liabilities or paid inside the period
Residency
Massachusetts
Note
Which standard applies to a particular child is MassHealth’s decision; the research did not settle a general children’s spend-down outside the Kaileigh Mulligan rule.

The trap: MassHealth does not pay the bills used to meet the deductible. They stay yours. That is why hospital financial assistance and the Health Safety Net matter alongside it.

Where I read this

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