Massachusetts Medicaid (MassHealth): A System Built for Continuity

There are states where Medicaid feels like a single narrow doorway:
step one inch outside the rules, and the door closes behind you.

And then there’s Massachusetts.

Massachusetts’ Medicaid program — called MassHealth — still has rules, limits, paperwork, and frustrations. It is not effortless, and it is not perfect. But structurally, it tells a different story than many states do. One that recognizes something fundamental:

Health needs don’t disappear just because income changes.
Disability doesn’t stop being real because someone works.
Care shouldn’t vanish because life doesn’t fit neatly into a category.

Let’s walk through how MassHealth works, slowly and clearly — like a long afternoon over tea.

The Big Picture: How MassHealth Is Organized

MassHealth is not one single program. It’s better understood as a system of pathways, sometimes called “coverage types” or “lanes.” Which lane you’re in depends on things like:

• Age

• Income

• Disability status

• Whether you need long-term care

• Whether you’re on Medicare

Some of these pathways use MAGI rules (the same tax-based system used by the ACA Marketplace). Others use non-MAGI rules, which are older and include asset limits.

This layered structure is important, because it allows Massachusetts to offer different solutions for different realities, rather than forcing everyone into the same narrow box.

MAGI MassHealth: Coverage Without Asset Tests

For many people under 65, MassHealth uses MAGI (Modified Adjusted Gross Income) rules.

These pathways generally cover:

• Children

• Pregnant people

• Parents and caregivers

• Adults ages 19–64 without Medicare

Income limits

For most non-elderly adults, Medicaid eligibility in Massachusetts extends to about 138% of the federal poverty level (FPL).

Children and pregnant people qualify at higher income levels than adults, reflecting higher medical needs and the state’s policy priorities.

Assets

Here’s something important — and often misunderstood:

MAGI Medicaid has no asset test.

Savings accounts, retirement funds, vehicles, and modest emergency funds are not counted. This matters deeply for people who have had to rebuild their lives after illness, job loss, or caregiving disruptions.

MassHealth Standard, CarePlus, and Family Assistance

Within the MAGI world, Massachusetts uses several named pathways.

MassHealth Standard

This is the most comprehensive coverage and often includes:

• Full medical benefits

• Behavioral health care

• Long-term services and supports (when clinically eligible)

Many children, pregnant people, adults with disabilities, and seniors fall here.

MassHealth CarePlus

CarePlus primarily covers non-elderly adults without dependents who meet income rules but don’t qualify for Standard.

It provides robust health coverage, but does not include long-term care services. That distinction becomes important if someone’s health needs change over time.

MassHealth Family Assistance

Family Assistance often covers:

• Children at higher income levels (up to about 300% FPL)

• Certain noncitizens with qualified immigration status

Coverage is strong, but some services (like long-term care or certain supports) may be limited or excluded.

The Standout: CommonHealth (This Is Not Typical)

Now we come to one of the most unusual and meaningful parts of the Massachusetts system.

What CommonHealth Is

CommonHealth is a Medicaid pathway specifically for people with disabilities who do not qualify for MassHealth Standard because of income.

This is critical:

• It is not a general buy-in program

• It is not available to nondisabled individuals

• Disability must be established under MassHealth’s rules

No Upper Income Limit

Here’s where Massachusetts truly diverges from many states:

CommonHealth has no upper income limit.

Instead of cutting people off when they earn “too much,” Massachusetts allows them to stay enrolled and contribute through sliding-scale premiums. These premiums generally begin around 150% of the federal poverty level, increasing gradually as income rises.

What this means in real life:

• A disabled person can work part-time or full-time

• Accept a raise or promotion

• Transition back into the workforce

…without losing access to Medicaid-covered care.

In many states, that same income change would trigger a sudden and destabilizing loss of coverage.

Assets and Aging: The Non-MAGI Side

For people age 65+, and for many long-term care pathways, MassHealth uses non-MAGI rules.

Asset limits

For seniors on MassHealth Standard, the commonly applied asset limits are:

• $2,000 for an individual

• $3,000 for a married couple

Certain assets are excluded (like a primary residence in many cases), but the rules are stricter than MAGI Medicaid.

Long-Term Care (LTSS)

Massachusetts covers long-term services and supports through MassHealth Standard, including:

• Nursing facility care

• Home- and community-based services (HCBS)

• Programs like PACE (Program of All-Inclusive Care for the Elderly)

Many community-based programs use an income framework tied to 300% of the federal SSI benefit, which in 2026 is $2,982/month for an individual. This higher income allowance helps people remain at home rather than entering institutional care.

The Layered Safety Net: Catching People Who Fall Through

Massachusetts does not rely on Medicaid alone.

Children’s Medical Security Plan (CMSP)

CMSP provides limited health coverage to children who are ineligible for MassHealth, often due to immigration status. It’s not full insurance, but it ensures children still have access to care.

Health Safety Net (HSN)

HSN helps cover certain services delivered at hospitals and community health centers for people who have no insurance or gaps in coverage.

Again — not full insurance. But importantly, not nothing.

This layering reduces the number of people who are completely shut out of care, a reality that is far more common in states without these backstops.

Why This Matters for Individuals

All of this structure translates into lived experience:

• People with disabilities can work without risking immediate loss of care

• Health coverage is more likely to adjust rather than disappear

• Transitions — returning to work, caregiving shifts, aging into Medicare — are less destabilizing

• Fewer people face sudden coverage cliffs after small income changes

This is what continuity looks like in policy form.

And Why It Matters Beyond the Individual

When coverage systems prioritize continuity:

• Employers see less benefits-driven job churn

• Return-to-work conversations become more realistic

• Accommodations are easier to sustain

• Burnout, presenteeism, and preventable turnover decrease

A Medicaid system doesn’t just shape health outcomes — it shapes economic participation.

Final Thoughts

Massachusetts is not perfect.
MassHealth still has complexity, paperwork, and limits.

But it shows what Medicaid can look like when a state designs for real human lives, not just eligibility categories.

When dignity, continuity, and flexibility are part of the system,
coverage becomes something people can build a life around —
not something they’re constantly afraid of losing.