The Division of Medical Assistance in MA

The Division of Medical Assistance (DMA) is responsible for the administration of the Medicaid program in Massachusetts. DMA also regulates health plans, long-term care facilities, and home care providers.

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Introduction

The Division of Medical Assistance (DMA), formerly the Bureau of Medical Services (BMS), is the agency within the Massachusetts Executive Office of Health and Human Services (EOHHS) that is primarily responsible for administering MassHealth, the Commonwealth’s Medicaid program. DMA also has responsibility for certain aspects of the Children’s health insurance Program (CHIP), also known as MassHealth Limited.

What is the Division of Medical Assistance?

The Division of Medical Assistance (DMA) is the Massachusetts state agency that administers the state’s Medicaid program. Medicaid is a health insurance program for low-income and disabled residents of the United States. In Massachusetts, Medicaid is called MassHealth. The DMA also administers the state’s Children’s health insurance Program (CHIP), which is a health insurance program for low-income children.

The DMA is responsible for ensuring that MassHealth members have access to high-quality, cost-effective health care. The DMA accomplishes this by working with a wide range of partners, including managed care organizations, provider networks, long-term care providers, hospitals, and community-based organizations.

What services does the Division of Medical Assistance provide?

The Division of Medical Assistance (DMA) is the state agency responsible for administering Medicaid and the Children’s health insurance Program (CHIP) in Massachusetts. DMA provides health care coverage for low-income residents of the state who meet eligibility criteria. Coverage is provided through a variety of programs, including MassHealth, the Commonwealth Care program, and the CHIP program.

DMA also provides oversight for the state’s network of community health centers, which provide primary and preventive care to low-income residents. In addition, DMA works with the state’s managed care organizations to ensure that Medicaid enrollees receive high-quality health care services.

How does the Division of Medical Assistance help Massachusetts residents?

The Division of Medical Assistance (DMA) is the state agency responsible for administering the Medicaid program in Massachusetts. Medicaid is a joint federal-state program that provides health insurance coverage to low-income and disabled individuals and families. DMA also administers the Children’s Health Insurance Program (CHIP), which provides health insurance coverage to low-income children who do not qualify for Medicaid.

DMA’s mission is to reduce the cost of health care for Massachusetts residents by ensuring that they have access to high-quality, Affordable Health Care DMA accomplishes this by working with health care providers, insurers, and other stakeholders to promote access to care, improve the quality of care, and control costs. DMA also provides direct assistance to Medicaid beneficiaries through its Eligibility Determination and Customer Service Centers.

What are the eligibility requirements for the Division of Medical Assistance?

In order to be eligible for the Division of Medical Assistance (DMA), residents of Massachusetts must meet certain income, resource, and categorical requirements.

Income:
DMA looks at both gross income and countable income when determining eligibility for MassHealth, the Children’s Health Insurance Program (CHIP), and Senior Care Options (SCO). Gross income is the total amount of money a household earns before taxes are taken out. Countable income is the amount of money that DMA considers when determining eligibility for its programs.

For most MassHealth members, DMA does not count all of a household’s gross income when determining eligibility. Deductions are subtracted from gross income to come up with countable income. The following are some examples of common deductions:
-a standard work deduction;
-deductions for child support payments that are being made to another household;
-a 20% earned income deduction; and
-deductions for Medicare premiums, medical expenses, and dependent care expenses.

Resources:
DMA considers both countable and exempt resources when determining eligibility for MassHealth, the Children’s Health Insurance Program (CHIP), Senior Care Options (SCO),One Care, and the Program of All-Inclusive Care for the Elderly (PACE). A resource is anything that a person owns that can be converted into cash and used to pay for medical care or other needs. Examples of resources include, but are not limited to: cash; cars; property (other than the person’s primary home); burial plots; life insurance policies with a face value of $1,500 or less per person; certain trust funds; and cash value in annuities.

Certain resources are not counted when determining eligibility for DMA programs. These resources are called exempt resources. Examples of exempt resources include, but are not limited to: a primary home; one car per adult member of the household; certain burial plots; life insurance policies with a face value greater than $1,500 per person; certain deferred compensation plans, such as 401(k) plans and individual retirement accounts (IRAs); certain pension plans; certain trust funds set up specifically for disability-related expenses; cash value in annuities above a certain limit; and college savings plans

How can I apply for the Division of Medical Assistance?

The Division of Medical Assistance (DMA) is the state agency responsible for administering the MassHealth program.

There are four ways to apply for MassHealth:
-Online at https://www.mass.gov/gateway/masshealth-online-application
-By phone by calling the toll-free MassHealth Customer Service Line at 1-800-841-2900 Monday through Friday, 8:30 a.m. – 5 p.m.
-In person by going to your local MassHealth office – find your local office at https://www.mass.gov/locations/masshealth-local-offices
-By downloading and mailing in a paper application, which you can get at https://www.mass.gov/forms/masshealth-application

What is the appeals process for the Division of Medical Assistance?

You can request a hearing if you disagree with a decision made by the Division of Medical Assistance (DMA).

The DMA is the state agency responsible for administering the Medicaid program. Medicaid is a health insurance program for low-income residents of Massachusetts.

If you are not happy with a decision made by the DMA, you can file an appeal. An appeal is a request for a review of the DMA’s decision. When you file an appeal, you are asking the DMA to take another look at its decision.

You can file an appeal in writing or over the phone. To file an appeal in writing, send a letter to the DMA’s Office of Hearings and Appeals. The address is:

Office of Hearings and Appeals
Division of Medical Assistance
600 Washington Street, 5th Floor
Boston, MA 02111

To file an appeal over the phone, call the DMA’s customer service number at 1-800-841-2900.

Once the DMA receives your appeal, it will send you a letter to let you know that it has received your request for a hearing. The letter will also give you information about how to prepare for your hearing.

How can I get more information about the Division of Medical Assistance?

The Division of Medical Assistance (DMA) is responsible for the administration of the Medicaid program in Massachusetts. DMA also administers the Children’s Health Insurance Program (CHIP), known in Massachusetts as MassHealth Limited. DMA works with health care providers, and with state and federal agencies, to make sure that low-income residents have access to high quality health care.

You can contact DMA by phone at (800) 841-2900, or by mail at:

Division of Medical Assistance
One Winter Street, 2nd Floor
Boston, MA 02108

Conclusion

As of 2014, The Commonwealth of Massachusetts has transitioned to a new eligibility and enrollment system for MassHealth, the state’s Medicaid program. The new system is called the Health Care Eligibility and Enrollment System (HCEES). The HCEES will streamline the process of enrolling in and maintaining MassHealth coverage.

Resources

There are a number of resources available to help you with the Division of Medical Assistance in Massachusetts. Here are some of the most helpful:

-The Division of Medical Assistance website: This website provides information on eligibility, coverage, benefits, and more.
-The MassHealth Customer Service Line: This line can help you with questions about your coverage, benefits, and more.
-Your local MassHealth office: You can visit your local office to get help with questions about your coverage or to apply for coverage.