Masshealth Coverage for Adopted Children
Masshealth is the state Medicaid program in Massachusetts, and provides insurance coverage for anyone in the state who qualifies based on income or disability. Children adopted through foster care in Massachusetts are also eligible for insurance coverage through Masshealth, but this is a very small population within the Masshealth system. For that reason, a lot of the automatic processes generated by Masshealth don’t apply to our kids. This can be confusing and frustrating. There are four scenarios that most commonly lead to questions and confusion:
1. You get a letter in the mail from Masshealth telling you that you must choose a plan, or your child will be auto-enrolled in a plan.
2. Your child’s pediatric provider is telling you that they only participate in a managed care plan with Masshealth, not “Masshealth Standard.”
3. You apply for Masshealth coverage for your family when your adopted child already has Masshealth
4. You decide to put your child on your commercial insurance, and Masshealth becomes secondary coverage.
Below is an FAQ that covers some of these issues, and more (e.g., what if I move out of state?). Here we adapt some information provided by the DCF medical social worker for the entire state, Jessica Coolidge, who interfaces between DCF and Masshealth regularly. She is a wealth of information, and can be contacted by any adoptive parent who is running into barriers with the Masshealth system, and has not found the information to help them on this page.
Until what age does a child adopted through DCF qualify for Masshealth coverage?
Children are automatically eligible up until they turn 18. Between the ages of 18 and 21, the Subsidy Unit has specific criteria for adopted children to maintain Masshealth coverage. Importantly, here is some information about the Affordable Care Act (ACA) and Masshealth coverage for adopted children:
- There is a Masshealth category known as “former foster care youth” that covers youth up until the age of 26. Adoptive parents sometimes think this includes their adopted children, but it does not. “Former foster care youth” is defined under the ACA as children who were in foster care when they turned 18 and aged out of care without being adopted.
- Under the ACA, parents can keep their children on their private health insurance until the age of 26. Once an adopted child is no longer eligible for Masshealth (either at 18 or, if they’re eligible, until 21), adopted children are eligible to go on their parents’ insurance until the age of 26.
- Adopted children can also apply for Masshealth one their own (and qualify based on their independent income) after they are no longer eligible for Masshealth through DCF subsidy.
How does Masshealth work once a child is adopted?
When your child is adopted, the Masshealth application is generated automatically under the child’s new name, through their subsidy application. Masshealth will consider this a new person in their system and automatically generate the same correspondence and forms that any new Masshealth recipient would receive. You will receive a letter from Masshealth telling you that you must pick a Masshealth plan or the system will pick one for you. Although this is the case for most people on Masshealth, there are two groups of individuals who do NOT have to pick a plan: Children who receive Masshealth through DCF subsidies, and children who have been deemed disabled by the Social Security Administration. Unfortunately, the system does not differentiate these two populations from everyone receiving Masshealth, and will send out all the same information.
The Bottom Line:
- Once the Subsidy picks up (usually 1-2 months post the legalization date), the child will be issued a brand new Masshealth ID with their new legal name.
- Until that time, the family should keep using the same Masshealth ID and pre-adoptive name at all provider offices
- Not until the new Masshealth card is received should they update providers with the new name/ Masshealth ID.
Does a family need to choose a Masshealth Plan?
Although you can pick a managed care plan through Masshealth, it’s typically better if you don’t. When not affiliated to a particular plan within Masshealth, your child will be covered on a “Fee for Service” basis through Masshealth. Any pediatric practice in the state of Massachusetts that accepts any Masshealth program also (by default) is enrolled as a “Fee For Service” provider with Masshealth. Some refer to this as “Masshealth Standard,” but most providers don’t use that terminology. You should say “Fee for Service.” Importantly, although pediatric practices in Massachusetts that accept any Masshealth plan are automatically enrolled as a fee for service provider, this is not true for all specialty providers.
The Bottom Line
- Whenever a MH ID is issues, MH sends out an auto notice asking a family to choose a plan
- The family should ignore this because the child is covered through MH via the DCF subsidy. They are exempt from choosing a plan
- The child will automatically be on “Fee For Service” with Masshealth (sometimes referred to as “Masshealth Standard,” but most providers will know it as “Fee for Service”).
Can I put my adopted child on my employer-sponsored insurance?
Some families opt to put their adopted child on their private Commercial insurance, which they are entitled to do. In most cases, the coverage your child will get through commercial insurance will not be as robust as the coverage your child will receive through Masshealth.
The Bottom Line:
- Yes, you can. However, the family should be made aware that this automatically becomes the primary insurance
- Having Masshealth as secondary insurance can impact access to services.
- A family does not need to put their child on their employer sponsored insurance, even though Masshealth might tell them they do. Again, this refers to families who have Masshealth coverage that is not through a DCF subsidy.
I’m calling Masshealth and being given different information than what I’m reading here. What should I do?
When you contact Masshealth customer service, you are actually calling a call center contracted by Masshealth to answer customer questions and concerns, not Masshealth itself. Call center staff have high turnover and they’re not all well trained on the unique aspects of Masshealth coverage for children adopted through foster care. They might tell you that you have to choose a plan (you don’t). If these issues happen, here are some suggestions:
- Gently remind the representative that your child was adopted through foster care and they receive Masshealth through a DCF subsidy. Sometimes this is enough to job their memory and understand that there are some differences compared to the general Masshealth population.
- Ask to speak to a supervisor, and let them know about the adoption through foster care (as described above).
- If you’re still running into problems, request the call reference number of the call you’re on. You can then provide this to Jessica Coolidge via email (email@example.com). She is the DCF medical social worker for the entire state and has given us permission to share her contact information for this purpose. She is extremely responsive via email.
I’m calling Masshealth and being told I’m not authorized to speak to them about my adopted child’s coverage. Why?
Your adopted child’s Masshealth application is generated automatically through the DCF subsidy unit, and the information from the subsidy application is used. Unfortunately, there is only space in the Masshealth system for one authorized adult to be listed. If two parents have adopted together, only one of them will be authorized. The adult can be changed, but two adults can’t be listed simultaneously. Other issues can occur that you’ll want to watch out for:
- You should never give Masshealth your adopted child’s social security number (SSN). If your child has the same SSN after adoption as they did before adoption, Masshealth will use the SSN you provide and pull up the child’s coverage from foster care, which will now be cancelled. Masshealth does not need your adopted child’s social security number, and you should never give it to Masshealth in order to avoid cross referencing two difference policies for the same person.
If I’m applying for Masshealth for my entire household and I’m an adoptive parent, should I include my adopted children on the Masshealth application
If you’re applying for Masshealth, you can include your child in your household size, but do NOT apply for coverage for them.
The Bottom Line:
- Yes, you can include your adopted child on your application, BUT make sure to check the box that says you are not applying for them.
- It is important to have your adopted child(ren) counted in your household number, but they already have Masshealth coverage. Adding them to your application will generate duplicate coverage for them.
What happens to Masshealth once I adopt, if I’m living out of state?
Your child will be eligible for coverage through Medicaid in whatever state they are a permanent resident in.
Some Additional Details:
- DCF is now automatically doing what is known as an ICAMA (Interstate Compact on Adoption and Medical Assistance) referral. This means that if you are residing in another state, once the subsidy picks up, you will receive a notice that your child will be picked up via Medicaid in that State.
- If you are residing in MA and at some point move to another state, you should notify the Subsidy Unit.
- Once you and your child are a permanent resident of another state, you should not have Masshealth coverage anymore, and will not be able to cross into Massachusetts to continue seeing the child’s former providers through Masshealth. Your child will be eligible for your new home state’s Medicaid coverage, and should not be covered through Masshealth.
What if we accidentally selected a Mass health plan after adoption. Can we get our child out back into mass health standard fee of service? Also, how does coverage work with mass health when we travel out of state?
Great questions, Sarah! Our understanding is that you can get your child off a managed care plan and onto “Standard” or “Fee for Service.” You might need some advocacy from the Medical Social Worker, whose contact appears above. As for interstate travel, I’m actually not sure about that. But I recommend you contact Masshealth customer service to find out about the limits of emergency coverage when out of state. Good luck!
Yes – you can change the plan at anytime for a child who is receiving MH via DCF, as is the case for adopted youth who were adopted through us. Only those not receiving MH via DCF, are limited to only being able to change a plan during open enrollment periods.
Travel out of State: Unfortunately most provides out of state are not contracted with Medicaid from another state. This means that you could end up paying out of pocket for an out of state medical visit. Some families choose to purchase travel insurance to avoid this.
Our PCP stated we had to pick a specific plan in ordder to stay with them. Now we found a therapist that takes our adoptive daughter’s MassHealth, but just got a call that she doesn’t take the MassHealth plan we are in. She is going to send therequest to Masshealth directly will this work?
Hi Chris! It’s likely your PCP is misinformed. As long as a pediatric practice accepts *any* Masshealth plan, they can bill MassHealth “standard,” aka, “fee for service.” Importantly, this doesn’t pertain to specialists, only primary care. For your specific questions, I’d encourage you to reach out to Jessica Coolidge, DCF Statewide Medical Social Worker, whose contact information appears in this post. She can help you navigate the system directly, and/or possibly make a call on your behalf. She’s extremely helpful!
Any idea what a good contact number would be to contact mass health for services covered under cbhi? Thank you in advance!!
Hi Allison! In our welcome sessions, Morganne Crouser talks about CHBI services. Morganne is at JRI, and can be reached via email at: firstname.lastname@example.org