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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.
Contact for How to appeal a MassHealth 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.
During the COVID-19 national emergency, individuals have up to 120-days to request an appeal.
How to appeal How to appeal a MassHealth decision
- Fill out the Fair Hearing Request Form.
- Make a copy for yourself.
- Send a copy to the Office of Medicaid, Board of Hearings at:
100 Hancock St.
6th Floor
Quincy, MA 02171
- Fill out the Fair Hearing Request Form.
- Fax the form to the Office of Medicaid, Board of Hearings at 1-617-887-8797.
Updates to this are in process,
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.
- 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
- TDD/TTY: 711
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
Open PDF file, 45.07 KB, for
Fair Hearing Request Form
(English, PDF 45.07 KB)
Open DOCX file, 21.06 KB, for
Fair Hearing Request Form
(English, DOCX 21.06 KB)
Open PDF file, 84.04 KB, for
Fair Hearing Request Form (Large Print)
(English, PDF 84.04 KB)
Open PDF file, 43.77 KB, for
Cómo pedir una audiencia imparcial
(Spanish, PDF 43.77 KB)
Open DOCX file, 22.21 KB, for
Cómo pedir una audiencia imparcial
(Spanish, DOCX 22.21 KB)
Contact for How to appeal a MassHealth decision
Address
Phone
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.
Self-service available 24 hrs/day in English and Spanish. Other services available Monday-Friday 8 a.m.–5 p.m. Interpreter service available.
Related
- Language Services, Nondiscrimination Policy
- 130 CMR 610.000: MassHealth: Fair Hearing Rules
- MassHealth Board of Hearings Fair Hearing Decision Notification Form
- MassHealth Board of Hearings Inquiry Form for Eligibility Denial Notice Based on Trust Assets
- MassHealth Board of Hearings Quarterly Case Statistics