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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

MassHealth Customer Service Center

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.

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. 

If you have a disability and need an accommodation in order to attend or participate in your hearing, you can send us a Request for Reasonable Accommodation form to get the accommodation you need.

The Board of Hearings must receive your completed, signed request within 60 calendar days from the date you received the notice of the MassHealth agency’s action.

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 1-617-887-8797.

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.

The Board of Hearings is committed to providing meaningful access for all users, including users with disabilities. If you have a disability, you can request a reasonable accommodation to give you better access to the Board of Hearings by sending us a Request for Reasonable Accommodation form.

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

If you are looking to request the status of a decision pending on your eligibility appeal or would like to notify the EOHHS General Counsel that you have been denied eligibility based on trust assets, please see the forms in the related links. 

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
1-617-887-8797
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.

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