Masshealth Coverage for Adopted Children

updated October 2023

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. You do now need to respond to that letter and choose 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 within 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.

I’ve been told it’s time to re-apply or be re-authorized for my child’s Masshealth coverage. What do I do?

Nothing. If a child receives Masshealth through DCF subsidy (adoption), you do not have to re-apply to certify eligibility. This is only true for people who are eligible for Masshealth as a result of their financial situation. Your child’s Masshealth should never be cancelled by Masshealth (unless a child ages out).
The Bottom Line:

• Your adopted child will keep Masshealth coverage until they age out, and you do not have to certify eligibility in any way.
• Other household members who qualify for Masshealth through financial situations will need to re-apply.

Should an Adoptive Family choose a Masshealth Plan?

Starting in July 2023, Masshealth will auto-enroll a new member in a managed care plan, and we recommend that adopted children participate in a managed care plan through Masshealth that provides them the best coverage within their geographic region. You will receive a large envelope and letter letting you know that if you do not enroll in a plan, you will be auto-enrolled within two weeks. You can opt out of this and keep “Masshealth Standard” (or “Fee for Service), but the process is a little cumbersome (more on that below) and not always the best option.

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.

In fact, it is becoming more challenging to find specialists who accept Masshealth Standard because managed care has become the norm. Additionally, Masshealth Standard (“Fee for Service) doesn’t offer robust case management and other support services that managed care plans offered. For those reasons, it makes sense to carefully weigh the pros and cons of enrolling in a managed care plan or not. You should review the packet of information you receive from Masshealth and compare the plan options. As a child receiving Masshealth through DCF subsidy, you can change your plan any time without waiting for any “open enrollment” period.

If you still wish to opt out of selecting a Masshealth plan, you must call Masshealth and tell them you want to opt out. The problem is they will probably tell you this isn’t possible. You should elevate your inquiry to a supervisor, and if they still are not able to make the change, you can email Jessica Coolidge (statewide medical social worker; jessica.coolidge@mass.gov) with the name of the person you spoke to, what they reported, and the reference number of the call. She can then have Mashealth Operations opt the child out, but only if the parent as the authorized representative initiates the call first.

The Bottom Line

• Whenever a MH ID is issues, MH sends out an auto notice asking a family to choose a plan
• The family will need to choose a plan or be auto-enrolled in a plan.
• Although it is now not always the best option for children who have been adopted and are in a stable home, you can opt out of enrolling in a MassHealth plan.
• You can “opt out” of a plan by calling Masshealth and requesting it, which will likely not be honored, and then contacting the statewide medical social worker to fix the situation for you.

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. To make matters worse, Masshealth recently contracted with a new call center, and all the training done to inform prior call center staff about the nuances of DCF subsidy cases needs to be done anew. They will give you information that is different than what you have read here. 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 jog 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 (jessica.coolidge@state.ma.us). 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.

Have other questions? Email us and we’ll add them to this FAQ!

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