MassHealth Fee-for-Service

  • Description
  • Funding History
  • Proposals

MassHealth Fee-for-Service covers payments for coverage provided to children and adults through fee-for-service arrangements with providers.

Children in families with incomes up to 150 percent of the federal poverty level are eligible for MassHealth Standard, the most comprehensive health coverage program. Typically, these children enroll in a managed care plan (see MassHealth Managed Care).

However, certain groups of children or certain services are also covered under fee-for-service arrangements. For instance, if children have access to private insurance that is partially subsidized by MassHealth, MassHealth Fee-for-Service will cover the costs of benefits provided under MassHealth Standard that are not provided by the private insurance.

Children who are enrolled in Department of Children and Families (DCF) or Department of Youth Services (DYS) programs are not required to enroll in managed care plans and may receive coverage paid for by MassHealth Fee-for-Service.

MassHealth Fee-for-Service also covers services for children while a child's initial MassHealth application is undergoing eligibility review.

MassHealth policy changes sometimes result in program and funding shifts among MassHealth line items in the state budget, and children likely account for a very small amount of the costs funded from this line item. Use caution when comparing these line items from year to year.

Updated, March 2015

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