MassHealth Enrollment for a Grandchild With a Relative Caregiver in Massachusetts

MassHealth Does Not Count a Grandparent's Income

MassHealth uses Modified Adjusted Gross Income (MAGI) rules to determine a child's eligibility for health coverage. When a child lives with a grandparent or relative who is not their biological or adoptive parent — and the caregiver doesn't claim the child as a tax dependent — MassHealth applies a special non-filer household rule.

Under this rule, the child's "household" for Medicaid purposes consists only of the child and any biological or adoptive siblings living in the same home. The grandparent's income, pension, Social Security, and assets are entirely excluded from the calculation.

Children whose personal income is at or below 150% of the federal poverty level qualify for MassHealth Standard under this household rule.

Income Limits

MassHealth Standard covers children whose household income is at or below 150% of the federal poverty level. MassHealth Family Assistance (the CHIP tier) covers children between 150% and 200% FPL.

For a household of one child with no personal income, both thresholds are easily met. Even a child receiving Social Security survivor benefits of several hundred dollars per month typically stays well under the 150% FPL limit.

Once approved, the child is guaranteed 12 months of continuous eligibility — no interruption for minor income changes during the certification year.

If You Already Have TAFDC, MassHealth Is Automatic

Children approved for a TAFDC child-only grant are automatically enrolled in MassHealth. No separate health coverage application is needed. DTA transmits the eligibility data to MassHealth, and a MassHealth card arrives in the mail.

This is one of the strongest reasons to start with the TAFDC application: it opens two doors at once.

Applying Separately for MassHealth

If you are not applying for TAFDC — or if the child is not eligible for cash assistance — you can apply for MassHealth on its own.

Online: Create an account at mahealthconnector.org and complete the Application for Health and Dental Coverage (Form ACA-3 for anyone under 65).

By phone or mail: Call the MassHealth Customer Service Center or mail a paper ACA-3 form. The form asks about the child's living situation, household members, and income. For a non-filer kinship household, the relevant section is the one identifying the child's relationship to the adults in the home — this triggers the non-filer rule.

Any relative caregiver can file the application on the child's behalf. You do not need legal guardianship or a court order to apply for health coverage.

Medical Consent Is Separate From Coverage

Getting the child on MassHealth solves the insurance question, but it does not automatically give you the legal authority to consent to medical treatment. For routine medical and dental care, you need either a Caregiver Authorization Affidavit under M.G.L. c. 201F (no court involvement) or a legal guardianship order.

Without one of these, a doctor's office may treat the child in an emergency but hesitate to provide routine care.

Renewal and What to Do if Coverage Lapses

MassHealth sends an annual pre-populated renewal form. Verify the information and return it within 45 days. If coverage ends because MassHealth did not receive the renewal information (a procedural termination), there is a 90-day reconsideration window — submit the missing form within that period and coverage can be restored retroactively.

If MassHealth denies, reduces, or terminates coverage, you can appeal to the MassHealth Board of Hearings within 60 calendar days from the date the notice was mailed. To keep coverage active during the appeal, submit the hearing request before the adverse action takes effect or within 10 calendar days of the notice mailing date.

The Massachusetts kinship financial help guide covers MassHealth enrollment alongside TAFDC and SNAP in one coordinated sequence, with a renewal calendar and appeal-deadline tracker for all three programs.

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