The MassHealth agency is the payer of last resort and pays for health care and related services only when no other source of payment is available, except as otherwise required by federal law.

1. (A) Health Insurance. Every applicant and member must obtain and maintain available health insurance in accordance with 130 CMR 505.000: Health Care Reform: MassHealth: Coverage Types. Failure to do so may result in loss or denial of eligibility unless the applicant or member is

   1. (1) receiving MassHealth Standard or MassHealth CommonHealth; and
   2. (2) younger than 21 years old or pregnant.

2. (B) Use of Benefits. The MassHealth agency does not pay for any health care and related services that are available

   1. (1) through the member’s health insurance, if any; or

   2. (2) at no cost to the member including, but not limited to, any such services that are available through any agency of the local, state, or federal government, or any entity legally obligated

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Trans. by E.L. 253 Rev. 02/13/2026

130 CMR 503.000: HEALTH CARE REFORM: MASSHEALTH: UNIVERSAL ELIGIBILITY

REQUIREMENTS

to provide those services.

1. (C) Employer-sponsored Health Insurance. The MassHealth agency may enroll MassHealth members in available employer-sponsored health insurance if that insurance meets the criteria for payment of premium assistance under 130 CMR 506.012(B): Criteria.