MassHealth and other programs offer coverage of varying scope to people based on their age, family income, employment and disability status. The following flowcharts present the eligibility pathways into health care coverage programs in Massachusetts.

The charts are categorized according to different population groups:

Children Under 1 Year of Age

Children 1 to 18 Years Old

Parent/Caretaker (19 or older) of Dependent Child

Pregnant Women of Any Age

Considered Disabled by SSA or State Criteria

HIV-Positive Individual

Working Adult with No Children

EAEDC Recipient or Unemployed Adult

Adults Age 65 or Older with No Dependent Children

Long-Term Care Coverage for Individuals 65 and Older

Prescription Drug Coverage

To find out the public health insurance program(s) for which a person may qualify, choose the population group above that best describes them. Click on that group, and proceed down the flowchart by following the series of “yes” or “no” questions till you arrive at the appropriate coverage program.

Once you reach a particular program at the bottom of the flowchart, please see the explanations provided on the Program Descriptions page for information on the program and contact information for the appropriate agency or organization. Clicking on the numbered blue boxes will link you to the appropriate item on the Program Descriptions page. If you are unable to use the image map, the numbers on the boxes correspond to the numbers on the Program Descriptions page.

In some cases, an individual may fit into more than one population group, such as a child between 1-18 years old who is also disabled or a woman who is pregnant and disabled. Individuals who fall into more than one population group should look at both flowcharts to determine the coverage which provides them the most comprehensive benefits. The flowcharts are designed so that the population groups progress from those eligible to receive the most comprehensive coverage to those eligible to receive the least comprehensive coverage. Therefore, it is important to choose the description that affords an individual the most comprehensive coverage.

Definitions of terms used in the flowcharts are provided in the Definitions section. Phone numbers have been included, where available. Also, a Federal Poverty Level chart is included to assist in determining financial eligibility for MassHealth programs.