Federal, exists in every state
MassHealth routes when ordinary child coverage does not fit
MassHealth has other coverage routes for children with disabilities whose families earn too much for Standard.
What it is
MassHealth has other coverage routes for children with disabilities whose families earn too much for Standard.
CommonHealth covers qualifying disabled children under 18 who cannot get Standard, with a premium that rises with income. Kaileigh Mulligan ignores parents’ income and assets, but requires hospital or nursing-facility care needs. The hospital enrollment specialist can compare both routes with ordinary child coverage.
Eligibility rules
- CommonHealth’s under-18 disability route has no income ceiling or institutional level-of-care test; a premium can apply.
- Kaileigh Mulligan disregards parents’ money but tests the child’s own finances and hospital or nursing-facility level of care.
- MassHealth has 90 days to decide an application based on disability.
What you get
- Another way into MassHealth when the ordinary income route does not fit.
Different tests
- An SSI disability decision and a nursing or institutional assessment answer different questions.
If you decide to apply
- Ask the hospital enrollment specialist to compare Standard, CommonHealth and Kaileigh Mulligan.
- Ask the oncology team for records describing your child’s disability and daily care needs.
MassHealth, 800-841-2900 · Official page ↗
After you apply
- The written decision names the coverage category, effective dates and any premium.
Good to know
CommonHealth does not require an SSI cash award. MassHealth can arrange its own disability evaluation.
Other details
- The specialist can compare the premium with the costs your work plan leaves unpaid.
- Turning 18 changes the CommonHealth review rather than automatically ending all eligibility. MassHealth confirms the adult disability route and coverage continuity.
Related Massachusetts cards: CommonHealth · Kaileigh Mulligan · MassHealth deductible.
Official sources
“If Standard does not fit, would CommonHealth or Kaileigh Mulligan help us, and could you help us compare their costs and apply?”
Why I’m asking: I want to understand the disability routes before assuming our income rules out MassHealth.
More background and detailed requirements
How this works
CommonHealth covers qualifying disabled children under 18 who cannot get Standard, with a premium that rises with income. Kaileigh Mulligan ignores parents’ income and assets, but requires hospital or nursing-facility care needs. The hospital enrollment specialist can compare both routes with ordinary child coverage.
- Another way into MassHealth when the ordinary income route does not fit.
- Ask the hospital enrollment specialist to compare Standard, CommonHealth and Kaileigh Mulligan.
- Ask the oncology team for records describing your child’s disability and daily care needs.
CommonHealth’s under-18 disability route has no income ceiling or institutional level-of-care test; a premium can apply.
Kaileigh Mulligan disregards parents’ money but tests the child’s own finances and hospital or nursing-facility level of care.
MassHealth has 90 days to decide an application based on disability.
An SSI disability decision and a nursing or institutional assessment answer different questions.
The written decision names the coverage category, effective dates and any premium.
The specialist can compare the premium with the costs your work plan leaves unpaid.
Turning 18 changes the CommonHealth review rather than automatically ending all eligibility. MassHealth confirms the adult disability route and coverage continuity.
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 which state option fits, confirm its application requirements and gather the requested financial and medical records.
Your social worker
Names the state's option and its phone number, and sends the medical application paperwork to the clinician who writes it.
The care team
Writes the medical application paperwork: diagnosis, treatment plan, daily care.
- Who decides
- The state Medicaid agency's disability unit
- Ask your social worker
- “Which option does this state have for a child with leukemia whose family is over the income limit: Katie Beckett, a buy-in, or SSI? Who on the team writes the medical application paperwork, and how soon can we file?”
How to apply
First step: Ask the hospital enrollment specialist which actual state Medicaid route fits and when to submit the required application.
- Ask which option the state runs for a child over income.
- File within two weeks while the medical evidence is fresh.
- Never drop a plan a buy-in requires.
Where it starts: The state's TEFRA, buy-in or SSI-linked application
What to gather
- Pathology report and the oncologist's letter with the diagnosis date
- The child's own accounts (most options test the child's money, not yours)
- Pay stubs if the option charges a premium by income
How long: Up to 90 days by federal rule for a disability-based application. The state item says what is typical.
What a yes looks like
Medicaid behind your plan with a card, sometimes a premium notice, and a review date (often near the end of treatment).
What a no looks like, and the next move
“Over the child's savings”, “level of care not met” or “no such option here”. The letter names the test that failed, and each has its own appeal.
Watch out
- The agency checks documented disability, the program's financial rules and any required care assessment separately. Do not assume a diagnosis satisfies every requirement.
- The buy-in states (Colorado, Iowa, Louisiana, North Dakota, Texas) can require you to take an employer plan when the employer pays half the premium. Then the buy-in premium is often lower.
- Spend-down (medically needy) is the last resort, not the first option.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 7, 2026.
What it is worth
Full Medicaid behind your plan, sometimes for a premium, in a family whose income is far above the ordinary line.
Covers: Full Medicaid benefit package · Home services through EPSDT and waivers once Medicaid is in place
Legal protection: Buy-in premiums and cost-sharing capped at 5% of income up to 200% FPL and 7.5% at 200–300%
What it costs the family: $0 in TEFRA states (Nevada excepted). A premium by income in buy-in states (Texas up to $230. Louisiana $0 to $35).
The eligibility facts, as published
- State specific
- yes
- Non magi
- yes
- Disability standard
- Where the route uses the SSI medical standard, documented acute leukemia is considered disabling for at least 24 months from diagnosis or relapse, or at least 12 months after transplant, whichever is later; financial and other program requirements still apply
- Buy in ceiling
- up to 300% FPL, state-selected
- Employer plan rule
- buy-in states may require enrollment in an employer plan that pays 50% or more of the dependent premium
Decisions this site cannot make: Child disability · Child's own finances (most options) · Level of care where the option requires it
Expect friction on: Medical packet · Separate agency desks
The trap: Separate requirements can include documented disability, financial eligibility and an assessment of care needs. Some routes count parental finances. Meeting one requirement does not establish eligibility.
What changes by state: Which option exists, whether there is a premium (buy-ins charge by income. Nevada charges for TEFRA), and the level-of-care standard.
Where I read this
- Medicaid Program — Centers for Medicare & Medicaid Services, read August 27, 2026
- Childhood Listing 113.06 Leukemia — Social Security Administration, read August 27, 2026
- Home and Community-Based Services 1915(c) — Centers for Medicare & Medicaid Services, read August 27, 2026
- Full List of Medicaid Waivers and Programs — Kids’ Waivers, read August 27, 2026
- 42 CFR 435.912: Timely determination of eligibility — Cornell LII (eCFR mirror), read September 7, 2026