How to appeal if MassHealth denies coverage

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:

There are three steps to the MassHealth appeals process. One: Request a fair hearing. This is a formal session in court where you can explain why you disagree with the denial. Fill out the request form (download below) and send it in within 30 days of getting the denial letter. Two: Prepare for your hearing. Read your rights on the Fair Hearing Request Form. Gather any documents that show why your family member should qualify. These could be reports from doctors, therapists or others. Ask for help if there's anything you don't understand. (See list below). Three: Attend the hearing and explain why you disagree with the decision. Get there on time, and contact the Board of Hearings at 617-847-1200 if you are running late or need to reschedule. Bring your family member with you if they are over the age of 18 and you do not have Power of Attorney, Guardianship, or Authorized Representative status.

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.

Here's who to all to get help with the appeals process: Health Care for All, 1-800-272-4232, Autism Insurance Resource Center, 1-774-455-4056, MassHealth, 1-800-841-2900, Health Law Advocates, 617-338-5241.

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

www.ne-arcautismsupportcenter.org

 

Family Autism Center (Westwood) - serves Norfolk County

781-762-4001, ext. 310

www.arcsouthnorfolk.org/family-autism-center.html

 

Community Autism Resources (Swansea) - serves Southeastern region, Cape Cod & Islands

508-379-0371 or 1-800-588-9239

www.community-autism-resources.com

 

Community Resources For People With Autism (Easthampton) - serves Western region

413-529-2428, ext. 121 or 1-800-892-7003

www.communityresourcesforautism.org

 

TILL & Boston Families for Autism (Dedham) - serves Greater Boston

781-302-4835

www.tillinc.org

Source: MassHealth

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