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. (English and Spanish versions listed below.)

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. (English and Spanish versions listed below)
  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. (English and Spanish versions listed below)
  2. Fax the form to the Office of Medicaid, Board of Hearings at (617) 847-1204.

More info about How to appeal a MassHealth decision

You need to submit your request within the timeframes listed on the Fair Hearing Request Form. 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.

  • Main: (617) 847-1200
  • Toll free: (800) 655-0338

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.

  • Main: (800) 841-2900
  • TTY: (800) 497-4648

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

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

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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