General Laws of Massachusetts - Chapter 118E Division of Medical Assistance - Section 16 Primary and supplemental medical care and assistance program for disabled residents; assistance program for chronically ill or disabled persons forced to leave employment or substantially reduce work hours

Section 16. The division shall establish a program of primary and supplemental medical care and assistance for certain disabled residents of the commonwealth including persons who are blind who are not eligible for medical assistance pursuant to Title XIX of the federal Social Security Act. The benefits of such program shall be available to all such persons (1) who are not covered for medical costs relative to their disability by an employer’s group health insurance plan, (2) who are not eligible for medical assistance under any work incentive programs with federal participation, and (3) who, if not engaged in substantial gainful activity, would meet all eligibility requirements for supplemental security income under the provisions of Title XVI of said Social Security Act at the time of application for said program of medical care and assistance. Subsequent to their enrollment in said program, such disabled residents may continue in enrollment in said program notwithstanding the fact that they no longer meet the financial requirements of said Title XVI in accordance with income requirements established by the division. The cost of such program shall be funded, in part, by premium contributions, co-payments, and deductibles contributed by enrollees according to a sliding scale schedule designed by the division.

The division shall further establish a program of assistance for persons forced to leave employment due to the onset or worsening of a severe and chronic disability or illness or whose access to employer sponsored health insurance is jeopardized by a substantial reduction in work hours as a result of such disability or illness. The benefits of such program shall provide for assistance in paying health insurance premiums offered through a group plan of health insurance sponsored by the employer for those persons whose continuing disability or illness would likely result in their becoming eligible for benefits under this chapter; provided that the cost of such benefits shall be paid, in part, by payments from such persons according to a sliding fee schedule established by the division.

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Last modified: September 11, 2015