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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.
Fair Hearing Request Form  Cómo pedir una audiencia imparcial 

Contact

Office of Medicaid, Board of Hearings

Phone

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

The Details

What you need

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. 

During the COVID-19 national emergency, individuals have up to 120-days to request an appeal.

How to appeal

  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.

Updates to this are in process,

More info

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. 

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

Fair Hearing Request Form (PDF 45.07 KB)
Fair Hearing Request Form (DOCX 21.06 KB)
Fair Hearing Request Form (Large Print) (PDF 84.04 KB)
Cómo pedir una audiencia imparcial (PDF 43.77 KB)
Cómo pedir una audiencia imparcial (DOCX 22.21 KB)

Contact

Address
Mailing Address
100 Hancock Street, 6th Floor, Quincy, MA 02171
Directions 
Phone
Main: (617) 847-1200
Toll free: (800) 655-0338
Fax
1-617-887-8797
Phone
Main: (800) 841-2900

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

TDD/TTY: 711

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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