How to appeal if MassHealth denies coverage

May 06, 2019 15:21

If MassHealth decides your family member does not qualify for a health plan or for disability status, you have the right to appeal.

Click the boxes below and to learn the steps and find local resources to help you:

To request a fair hearing, click the link at the bottom of the page to download a PDF of the form.

If your family member is over 18 and you have Power of Attorney or Guardianship, you must include a copy of those documents AND the MassHealth Authorized Representative Designation form.

Click the link at the bottom of the page to download a PDF of the form.

After you fill out the form, you can mail it to:

Board of Hearings

Office of Medicaid

100 Hancock Street, 6th Floor

Quincy, MA 02171

If you do not request a hearing within 30 days after you receive the denial letter, there is a different process you must go through.

Click the Letter Template - Eligibility Appeal More than 30 Days link at the bottom of the page to download a PDF of the form.

Sources: Health Care for All, Health Law Advocates, MassHealth

If you have a question, click the button below to find local resources to help you:

We understand how hard it can be to fill out the MassHealth paperwork!

If you still need help after reading this Guide, here are some other ways to get help. (Remember, you can print out this list and keep it handy!)

Call MassHealth: 1-800-841-2900. If you need an interpreter, they will get one.

Call the Family-to-Family Health Information Center at 1-800-331-0688 ext. 301: You can get free, confidential help navigating the MassHealth system. Staff can help you through the process of applying, and help you understand the coverage options. This service is offered by Mass Family Voices, a project of the Federation for Children with Special Needs. You can also email them at massfv@fcsn.org

Call the UMass/Disability Evaluation Services (DES) Help Line: 1-888-497-9890

If your family member has an autism diagnosis, you can contact the Autism Insurance Resource Center or one of the state's 7 Autism Support Centers:

Autism Insurance Resource Center:

774-455-4056 or 800-642-0249

info@disabilityinfo.org

www.disabilityinfo.org/arica

Autism Alliance of Metrowest (Natick)- serves Metrowest, Middlesex West

508-652-9900

www.autismalliance.org

Autism Resource Center (West Boylston) - serves Worcester, North Central & South Valley areas

508-835-4278

www.autismresourcecentral.org

Autism Support Center (Danvers) - serves Northeast region

978-777-9135 or 1-800-728-8476