Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth


	MassHealth
	Acute Inpatient Hospital Bulletin 135
	September 2008

	TO:	Acute Inpatient Hospitals Participating in MassHealth

	FROM:	Tom Dehner, Medicaid Director

	RE:	Revised Medical Benefit Request and Senior Medical Benefit Request Forms


Background
Effective July 1, 2006, Massachusetts requires individuals who claim to be U.S. 
citizens or nationals to provide acceptable documentation of their citizenship 
and identity. This one-time verification is required during either the initial 
application process for new applicants or the MassHealth annual eligibility 
redetermination process for members who have not previously provided the 
documentation.

In an effort to assist individuals in providing acceptable documentation of 
citizenship, MassHealth will institute an automated match process with the 
Massachusetts Department of Public Health Registry of Vital Records and 
Statistics (RVRS) to certify citizenship for a Massachusetts-born applicant or 
member, upon his or her request. The Medical Benefit Request (MBR) and Senior 
Medical Benefit Request (SMBR) have been revised to collect additional 
information to support the match process.
	

Changes to MassHealth Publications
MassHealth publications that were revised in August 2008 have been updated to 
allow a Massachusetts-born applicant to request assistance in certifying U.S. 
citizenship through RVRS. The following publications have been updated.
* Medical Benefit Request (MBR) form — a new Supplement D entitled “Help 
* Getting Proof of U.S. Citizenship for Persons Born in Massachusetts” 
* has been added.
*	Senior Medical Benefit Request (SMBR) form — a new Supplement B entitled 
“Help Getting Proof of U.S. Citizenship for Persons Born in Massachusetts” has 
been added.

Virtual Gateway Updates
Effective September 7, 2008, the Virtual Gateway will begin collecting 
additional information from Massachusetts-born applicants who request assistance 
in obtaining citizenship verification through RVRS. These enhancements 
correspond to the changes made to the paper MBR and SMBR.

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Supplies and Use of Revised Forms
Supplies of the revised MBR and SMBR are now available. To order supplies, call 1-800-841-2900 or e-mail your request to publications@mahealth.net.

When you receive a supply of the revised MBR or SMBR, please recycle 
earlier versions.

Questions
If you have any questions about the information in this bulletin, please contact 
MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to 
providersupport@mahealth.net, or fax your inquiry to 617-988-8974.