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How to appeal a MassHealth decision

As a MassHealth applicant or member, if you disagree with a MassHealth decision, or if we modify or deny a prior authorization (PA), you have a right to appeal the decision.

Office of Medicaid, Board of Hearings

The Details of How to appeal a MassHealth decision

What you need for How to appeal a MassHealth decision

You will need to fill out the Fair Hearing Request form within the timeframes listed on the form. Please be sure to read the form before completing. 

How to appeal How to appeal a MassHealth decision

  1. Fill out the Fair Hearing Request Form. 
  2. Make a copy for yourself.
  3. Send a copy to the Office of Medicaid, Board of Hearings at:

100 Hancock St.
6th Floor
Quincy, MA 02171

  1. Fill out the Fair Hearing Request Form
  2. Fax the form to the Office of Medicaid, Board of Hearings at (617) 847-1204.
  1. Fill out the Fair Hearing Request Form. 
  2. Email the completed form to BOH-FairHearingsRequest@mass.gov

More info for How to appeal a MassHealth decision

After you submit your appeal, the Board of Hearings will send you a notice of your hearing date, time, and place at least 10 calendar days before your scheduled hearing date.

At the hearing, you may represent yourself or be represented by a lawyer or other representative at your own expense. You may contact a local legal service or community agency to get advice or representation at no cost. To get information about legal service or community agencies, call the MassHealth Customer Service Center.

If you cannot come to the hearing for good cause, or if you need a telephone hearing, you must call the Office of Medicaid, Board of Hearings before the hearing date.

Failure to appear without having good cause, or having previously rescheduled the hearing, will result in the dismissal of your appeal.

You and/or your representative can review your MassHealth case file before the hearing. To do so, call the MassHealth Customer Service Center.

Your MassHealth case file is not kept at the Board of Hearings.

Click here to read about the appeals process in the MassHealth regulations

New Procedures for Fair Hearings and Certain Fair Hearing Decisions

The Board of Hearings will soon publish guidance on new procedures for

  • requests for fair hearings and
  • fair hearing decisions on
    • appeals of denial of eligibility and
    • requests for rehearing. 

These procedures will ensure reasonable promptness and administrative consistency.  

Two procedures are available for inquiries to the Board of Hearings:

90 DAY DECISION DEADLINE

This procedure is for inquiries from appellants waiting for decisions on an appeal of a denial of eligibility.

If a Board of Hearings decision is due to you within 14 days as calculated from the hearing officer's notice that you received specifying any required extensions of the decision deadline that apply, you MUST send a written demand for an eligibility decision to issue to you by the required 90-day deadline date to BOH-AppealsDecisionsStatusCheck@mass.gov in order to file a valid complaint for enforcement in court, if necessary, under this provision.

 TRUST NOTICE INQUIRIES   

This procedure is for inquiries about the denial of long-term care benefits based on trust assets, and for those who believe that their denial notice does not comply with court orders dated June 22, 2018, and October 11, 2018. You MUST send an email requesting notice clarification to trustinfo@mass.gov or you will be unable to challenge the trust notice on this basis at your hearing.

 

Downloads for How to appeal a MassHealth decision

Contact for How to appeal a MassHealth decision

Address
Mailing Address
100 Hancock Street, 6th Floor, Quincy, MA 02171
Fax
(617) 847-1204
Phone

Self-service available 24 hrs/day in English and Spanish. Other services available Monday-Friday 8 a.m.–5 p.m. Interpreter service available.

Self-service available 24 hrs/day in English and Spanish. Other services available Monday-Friday 8 a.m.–5 p.m. Interpreter service available.

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