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MassHealth
and Commonwealth Connector |
| This is the law: 956 CMR 3.00 Section 3.08 Eligibility Review (1) The Connector or its designee may review eligibility every 12 months. Eligibility may also be reviewed more frequently as a result of an Enrollee’s change in circumstances, or a change in Commonwealth Care eligibility rules. The Connector or its designee updates the case file based on information received as the result of such review. The Connector reviews eligibility: (a) by information matching with other agencies, health insurance carriers, and information sources as set forth in 956 CMR 3.06; (b) through a written update of the Enrollee's circumstances on a prescribed form; and (c) based on information in the Enrollee’s case file. (2) The Connector determines, as a result of this review, if: (a) the Enrollee continues to be eligible for Commonwealth Care; (b) the Enrollee’s current circumstances require a change in the Coverage Type, or Enrollee Premium Contribution; or (c) the Enrollee is no longer eligible for Commonwealth Care. (3) The Connector or its designee will notify the Enrollee if there is a change in the Enrollee’s Coverage Type or Enrollee Premium Contribution, or a change in Enrollee’s eligibility. (4) In the event of a determination that the Enrollee is no longer eligible, the Enrollee will be sent a notice of termination at least 14 days before the termination occurs. |
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