Massachusetts Medicaid

Last verified: June 2026

What is MassHealth, Massachusetts's Medicaid program?

MassHealth is Massachusetts's name for Medicaid and the Children's Health Insurance Program. The Executive Office of Health and Human Services (EOHHS) administers MassHealth. Massachusetts has a particularly long history of near-universal health coverage — the state's 2006 health reform law, Chapter 58 (often called "RomneyCare"), created a state coverage framework before the Affordable Care Act. When the ACA passed in 2010, Massachusetts was already ahead of most states on coverage levels.

Massachusetts expanded Medicaid under the ACA. As of 2025, approximately 2.1 million residents are enrolled in MassHealth, representing about 30% of the state's population. MassHealth covers doctor visits, dental care, prescriptions, behavioral health, long-term care, and other services for qualifying residents.

MAGI-based MassHealth — covering most adults, children, and pregnant individuals — has no asset test. The asset test applies only to programs serving seniors (age 65+) and people with disabilities who need long-term care.

How MassHealth is delivered: ACOs, managed care, and fee-for-service

Massachusetts delivers MassHealth through a distinctive Accountable Care Organization (ACO) model. MassHealth contracts with ACOs — networks of primary care providers, specialists, and behavioral health providers — to coordinate care for enrolled members. ACOs receive value-based payments and are responsible for the quality and cost of care for their attributed members. This approach distinguishes Massachusetts from states that rely solely on traditional managed care organizations.

Members are assigned to a primary care provider within an ACO. If a member has not selected a provider, MassHealth assigns one based on prior relationships and location. Members can request a different provider at any time by calling the MassHealth Customer Service Center at (800) 841-2900.

Apply for MassHealth online at mahix.org/individual/ (the Massachusetts Health Insurance Exchange). You can also apply through MA Login at mass.gov or in person at a MassHealth Enrollment Center.

Who qualifies for MassHealth?

MassHealth covers several distinct groups with different income limits. Standard adults qualify at or below 138% FPL. The program also covers children up to 300% FPL and has several specialized programs:

• Adults ages 19–64 (ACA expansion): at or below 138% FPL — approximately $21,597/year for a single person (2025 FPL base)
• Children ages 0–18: up to 300% FPL — one of the highest child income limits among Medicaid-expansion states
• Pregnant individuals: up to 200% FPL for full MassHealth coverage
• Parents and caretaker relatives: generally at or below 138% FPL
• Seniors (age 65+): income and asset-tested; standard asset limit is $2,000 per individual (2026)
• Individuals with disabilities: various programs including Frail Elder Waiver and personal care services
• Dual eligibles (Medicare + MassHealth): covered through Senior Care Options or traditional fee-for-service coordination

Source: MassHealth program financial guidelines (mass.gov), 2026 income standards. Verify current limits at mass.gov/information-for-masshealth-applicants.

MassHealth and the ConnectorCare bridge

Massachusetts operates a tiered coverage system. Adults who earn too much for MassHealth (above 138% FPL) but below 300% FPL may qualify for ConnectorCare — heavily subsidized private insurance through the Massachusetts Health Connector (the state's ACA exchange). ConnectorCare is not Medicaid, but it functions as a bridge between MassHealth and full-price private insurance.

Families with mixed eligibility — some members qualifying for MassHealth and others for ConnectorCare — can apply through the same portal. Massachusetts routes each household member to the correct program automatically based on income and category.

Massachusetts Medicaid topics

What does MassHealth (Massachusetts Medicaid) cover?

Medicaid covers a broad range of health services. Federal law mandates certain benefits — inpatient and outpatient hospital care, physician services, lab work, X-rays, and nursing facility services, among others. States add optional services on top of those. Dental, vision, and long-term home care coverage vary by state.

The national benefits overview lists required and commonly optional services. Check the MassHealth (Massachusetts Medicaid) website for the current state-specific benefit package.

How to apply

Most people can apply online through Massachusetts's Medicaid portal, by phone, or in person at a local eligibility office. The how to apply page walks through each method, what documents you'll need, and what to expect during the review period.

Under 42 CFR 435.912, states must process most standard Medicaid applications within 45 days (90 days for disability-based applications). Massachusetts must follow that federal timeline.