Massachusetts Health Safety Net: Eligibility, Deductible, and Hardship

You qualify for Massachusetts Health Safety Net eligibility if you live in Massachusetts and your household income sits at or below 300% of the federal poverty level — roughly $47,880 a year for a single person in 2026. The program pays for care delivered at Massachusetts acute care hospitals and licensed community health centers when you are uninsured or your insurance leaves gaps. A separate Medical Hardship track can help residents at any income level whose medical bills are large relative to what they earn.

Who Qualifies

Two tests decide standard eligibility: current Massachusetts residency and household Modified Adjusted Gross Income measured against the federal poverty level. Within the income limit, the program splits people into two bands with very different out-of-pocket exposure.¹

At or below 150% FPL, you pay no deductible. For a single person in 2026, that ceiling is roughly $23,940. The Health Safety Net covers eligible services from the first dollar.
Between 150.1% and 300% FPL, you qualify but must meet an annual deductible before the program starts paying. For a single person in 2026, the upper end of this range is approximately $47,880.²

The program then assigns you to Primary or Secondary status based on your insurance situation. HSN Primary is for people who are uninsured; the program acts as your payer at participating facilities. HSN Secondary is for people who have other health insurance but still meet the income requirements, and it picks up costs your primary insurance does not cover.¹ Secondary will not, however, cover your insurer’s copayments or pay bills your insurer denied because of a billing error or missing prior authorization.³

People enrolled in certain MassHealth programs, including MassHealth Limited, can qualify for HSN Secondary to access services their MassHealth coverage does not include.⁴ Students who meet the income criteria and carry a qualifying student health plan can also be placed in HSN Secondary.

The Deductible if You’re Between 150% and 300% FPL

If your income falls into the upper band, you are classified as HSN Partial regardless of whether you hold Primary or Secondary status. You must satisfy an annual deductible before the program begins paying.¹

Your deductible equals the greater of two figures: the lowest-cost ConnectorCare premium adjusted for household size, or 40% of the difference between your household income and 200% of the federal poverty level. For a single person earning $40,000 in 2026, that second calculation would run 40% of ($40,000 − $31,920), or roughly $3,232. The state compares that to the adjusted ConnectorCare premium and assigns whichever number is higher. Once you hit the threshold through out-of-pocket spending or payments by other insurance, HSN covers the rest of your eligible costs for the year.

Medical Hardship for Higher Incomes

Income above 300% FPL disqualifies you from standard HSN, but you are not automatically shut out. Medical Hardship covers Massachusetts residents at any income level whose medical bills consume a large enough share of their earnings. It is a one-time determination tied to specific bills, not ongoing coverage.⁵

Your allowable medical expenses must exceed a percentage of countable income that rises with your income bracket:

Between 305.1% and 405% FPL: medical expenses must exceed 20% of countable income.
Between 405.1% and 605% FPL: medical expenses must exceed 30%.
Above 605% FPL: medical expenses must exceed 40%.

Allowable expenses include paid and unpaid bills from any health care provider for services received up to 12 months before you apply, as long as you would be responsible for paying them. You can submit no more than two Medical Hardship applications within a 12-month period. The hospital or health center where you received care must help you assemble the application and submit it to the Health Safety Net Office within five business days of completion. If the provider misses that deadline, it cannot pursue collection against you for bills that would have been covered had the application been submitted on time.⁵

What the Program Covers

The Health Safety Net only reimburses care delivered at Massachusetts acute care hospitals and licensed community health centers. Services at private physician offices, independent clinics, or specialty practices that are not part of a hospital system or qualified health center are not covered.³

Within those facilities, covered services include emergency department visits, inpatient hospital stays, outpatient procedures, and certain diagnostic and laboratory work, all billed using MassHealth Standard payment codes. Prescription drugs are available through community health center pharmacies and hospital-based pharmacies, limited to the MassHealth formulary, with small copays roughly in the range of $1 to $3 per fill. Before you schedule non-emergency care, confirm that the specific department or clinic operates under an acute care hospital license or community health center designation. An affiliated urgent care center that operates under a separate license can leave you with the entire bill.

Common exclusions to watch for:³

Infertility treatment, though diagnosing infertility is covered.
Cosmetic surgery and other medically unnecessary procedures.
MassHealth and ConnectorCare copayments.
Insurance claims denied for billing errors, missing prior authorization, or out-of-network care.
Social, educational, and vocational services.
Experimental or unproven treatments.

How to Apply

Gather these before you start:

Proof of Massachusetts residency, such as a recent utility bill, current lease, or state-issued ID.
Social Security numbers for every household member on the application.
Income documentation: your most recent federal tax return and four consecutive weeks of pay stubs. If you receive government benefits, include unemployment statements or Social Security award letters.
Household information: number of people in your home, their relationships to you, and gross monthly income before taxes for each earner.

If you are under 65 and do not need long-term care services, you will file the ACA-3 application. People 65 or older, or anyone needing long-term care regardless of age, use the SACA-2 form.⁶ You can mail your application to the Health Insurance Processing Center in Taunton or submit it through the Massachusetts Health Connector online portal.⁷ MassHealth Enrollment Centers can help you fill out the forms, but applications still go to the Taunton processing center.

The state reviews your documentation and mails you a written determination telling you whether you have been approved, your category (Primary, Secondary, or Partial), your effective date, and any deductible. Approved applicants get an identification number that providers use to bill the state fund directly. Keep that number accessible for every medical visit.

Keeping Your Eligibility

HSN eligibility is not permanent. You must renew every year, and the state may also send requests for updated information before the year is up. Respond promptly. Ignoring these letters can cause a lapse in coverage, which means any services you receive during the gap become your personal responsibility.⁸ Renewal requires updated income documentation and confirmation of your household composition. If your income has changed since your last determination, your category or deductible may shift.

Appealing a Denial

If your application is denied or your eligibility category looks wrong, you can request a fair hearing through MassHealth. The fair hearing request form spells out the deadlines you must follow.⁹ For Medical Hardship determinations specifically, you have six months from the date of the official notification to request a review, and you will need to describe circumstances outside your control that materially affected the determination.¹ Hospitals that helped you apply cannot send your bills to collections while a review is pending.

1
Legal Information Institute. Massachusetts Code 101 CMR 613.04 – Eligible Services to Low Income Patients
2
U.S. Department of Health and Human Services. 2026 Poverty Guidelines
3
Legal Information Institute. Massachusetts Code 101 CMR 613.03 – Eligible Services Requirements
4
Mass.gov. MassHealth Limited + Health Safety Net
5
Legal Information Institute. Massachusetts Code 101 CMR 613.05 – Medical Hardship
6
Mass.gov. Eligibility Operations Memo 23-07 – Updated Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
7
Mass.gov. Contact MassHealth: Information for Members
8
Mass.gov. Health Safety Net for Patients
9
Mass.gov. How to Appeal a MassHealth Decision