MassHealth Navigation Cheat Sheet
Navigating MassHealth feels like a full-time job. This page won't replace a case manager, but it'll give you the scripts, strategies, and shortcuts other moms wish they'd had.
Programs You Should Know About
Not all MassHealth programs are created equal. Here are the ones that matter most for special needs families.
Full coverage for eligible children — includes therapies, specialists, equipment, and prescriptions.
For eligible adults and children with disabilities whose income is above the limits for MassHealth Standard. Disability and other eligibility rules apply, and a premium may apply.
A self-directed program for eligible members who need physical help with daily activities. Members recruit, hire, train, schedule, and manage their PCAs, with support available when needed.
Flexible funding for respite, camps, equipment, and more. Not MassHealth technically, but often used alongside it.
Free help navigating insurance coverage for autism and behavioral health — run through UMass Chan Medical School. They'll walk you through the entire application process.
What MassHealth May Cover for Your Child
MassHealth covers far more than most families realize. Coverage varies by plan type and may require prior authorization. Always confirm with MassHealth directly.
Therapies
- •Speech-language therapy
- •Occupational therapy
- •Physical therapy
- •ABA therapy (Applied Behavior Analysis)
- •Feeding therapy
- •Mental health counseling
Medical & Specialists
- •Pediatric specialists (neurology, developmental peds, etc.)
- •Prescription medications
- •Hearing aids & audiology
- •Vision care & glasses
- •Dental care (pediatric)
- •Nursing services (in-home)
Equipment & Supplies
- •Durable medical equipment (wheelchairs, walkers, etc.)
- •Orthotics & prosthetics
- •Communication devices (AAC)
- •Medical supplies (diapers for older children, etc.)
- •Adaptive equipment with medical justification
Support Services
- •Personal Care Attendant (PCA) hours
- •Home health aide services
- •Transportation to medical appointments
- •Early Intervention services (ages 0–3)
- •Day habilitation programs
- •Respite care (through some plans)
Important: Coverage depends on your child's specific MassHealth plan (Standard, CommonHealth, etc.) and medical necessity. Many services require a doctor's referral and prior authorization. If a service is denied, you have the right to appeal.
MassHealth Premium Assistance
If you or your child has employer-sponsored insurance (ESI), MassHealth may help pay the premiums — and cover gaps your private plan doesn't.
How Premium Assistance Works
- If your employer offers health insurance, MassHealth may determine it's cost-effective to pay your premiums instead of covering your child directly.
- MassHealth pays your employer premiums and then acts as secondary coverage — filling in gaps like copays, deductibles, and services your private plan doesn't cover.
- Your child keeps their MassHealth benefits for anything the employer plan doesn't handle (therapies, equipment, etc.).
- This is sometimes called the "Premium Assistance" or "Health Insurance Premium Payment" (HIPP) program.
💡 What Moms Should Know
- →You may be required to enroll in employer insurance if MassHealth determines it's cost-effective — but MassHealth covers the cost.
- →Premium Assistance doesn't reduce your child's benefits. MassHealth acts as wrap-around coverage.
- →If your employer plan has high copays or doesn't cover therapies, MassHealth picks up the difference.
- →To check eligibility, call MassHealth Customer Service and ask about the Premium Assistance / HIPP program specifically.
DDS — Department of Developmental Services
DDS is a separate state agency from MassHealth — but many families use both. If your child has an intellectual disability, autism, or a developmental disability, DDS may offer services MassHealth doesn't.
Who Qualifies?
- •Children and adults with intellectual disabilities (ID)
- •Children and adults with autism spectrum disorder (ASD)
- •Individuals with developmental disabilities diagnosed before age 22
- •Eligibility is determined by DDS, not MassHealth — you apply separately
What DDS Can Provide
- •Family Support funding (flexible $ for respite, camps, adaptive equipment, home modifications)
- •Service coordination — a dedicated coordinator who helps navigate everything
- •Respite care hours
- •Autism waiver services
- •Day habilitation & community programs
- •Employment support and job coaching
- •Residential services (group homes, shared living)
- •Transition planning support (ages 14–22)
💡 DDS vs. MassHealth — What's the Difference?
- →MassHealth is health insurance — it covers medical care, therapies, and equipment.
- →DDS is a service agency — it provides funding, coordination, and community supports for people with developmental disabilities.
- →You can (and often should) use both at the same time. They don't replace each other.
- →DDS Family Support is one of the most underused programs — it can cover things MassHealth won't, like summer camps, iPads for communication, or adaptive bikes.
How to Apply for DDS
- 1.Call your regional DDS office or the main line at (617) 727-5608 and ask for an eligibility application.
- 2.You'll need documentation of your child's diagnosis (evaluations, medical records).
- 3.DDS will review and determine eligibility — this can take several months.
- 4.Once eligible, you're assigned a Service Coordinator who helps you access Family Support and other programs.
- 5.Don't wait until your child is 22 — applying early gives you access to Family Support funding right away.
This guide is for informational purposes only. MassHealth policies change frequently. Always verify current eligibility and coverage directly with MassHealth.