Complete and submit the Long-term Care Supplement form if you need long-term-care services in a nursing home type facility, or if you are applying for or getting long-term-care services at home under a Home- and Community-Based Services Waiver.
The Long-term Care Supplement form is available through Adobe Acrobat. This allows you to complete, sign, and submit the form online. Follow these steps to use the online version of the form.
Step 1. Download the free version of Adobe Reader, if needed.
Step 2. Open the Long-Term Care supplement form.
Step 3. Fill in all the required information and submit your application electronically. (You must include a valid email address so Adobe can send you a link to complete the submission. This email address will also be sent to MassHealth, but we will not keep it in your records.)
Step 4. Look out for an email from Adobe Sign. It will have a link you can click to sign the form electronically. This document will not be sent to MassHealth until you have signed electronically.
Step 5: Check your email for a second message from Adobe. It will include a PDF copy of your signed form for your records.
This document has been formatted for use with screen readers.