This page, MassHealth Member Privacy Information, is offered by

MassHealth Member Privacy Information

See below for MassHealth member privacy information.

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. This law requires certain entities that provide or pay for health care (such as hospitals, insurance companies, and government health plans like MassHealth) to standardize the way they exchange health information. HIPAA also requires the health entities that must comply with its provisions to set up certain protections for the security and privacy of certain health information.

Under HIPAA, the U.S. Department of Health and Human Services issued a new regulation, known as the Privacy Rule. This rule went into effect on April 14, 2003. The Privacy Rule limits how MassHealth and other covered entities may use and share your protected health information (PHI). It also provides you with certain rights concerning your PHI.

PHI is any information that:

  • has to do with the physical or mental health of an individual, the provision of health care to an individual, or the payment for health care for an individual, and
  • identifies the individual, or can be used to identify the individual.

You have the right* to:

  • see and get a copy of your PHI;
  • ask MassHealth to change your PHI if you think it is wrong or missing information;
  • ask MassHealth to limit the use or sharing of your PHI;
  • ask MassHealth to get in touch with you in some other way, if reaching you at the address or telephone number that we have on file for you would put you in danger;
  • get a list, with certain exceptions, of when and with whom MassHealth has shared your PHI; and
  • get a paper copy of our Notice of Privacy Practices at any time.

*These rights may not apply in certain situations.

You must ask in writing and mail this request to:

MassHealth Privacy Office
Attn: Martha Young
MassHealth Privacy Office
One Ashburton Place, Room 1109
Boston, MA 02108

MassHealth is permitted to use or share your PHI for certain purposes without getting your permission, such as for activities involved in running the MassHealth program or paying your health-care providers for services you receive. There are also times when MassHealth is required by law to release your information. MassHealth does not need your permission to do this.

If you want MassHealth to share your information with someone, you may give MassHealth verbal permission to share your information over the telephone, once you verify your identity. However, you must be present with that person during the call. In this case, your permission will be good only for that call, and MassHealth will not be able to share your information with that same person on future calls unless you are present and give your verbal permission again.

If you want MassHealth to share your information with someone whenever they call without you being present, MassHealth needs to have your permission in writing. You will need to fill out a MassHealth Permission to Share Information form (PSI).

On this form, you must be clear about the types of information you want MassHealth to share, and for how long. If you give this permission, you can change it later, but each change must also be in writing. Once you fill out the PSI, you should mail it or fax it to the nearest you.

If you want another person to act on your behalf as your representative for eligibility purposes (including the right to sign MassHealth forms on your behalf and change your information), then you must complete an Eligibility Representative Designation form. The person you name on this form will have all the rights you have to information about your eligibility.

The Privacy Rule does not affect your choice of doctor and will not change your MassHealth benefits.

MassHealth takes your privacy very seriously. If you feel that MassHealth has violated your privacy rights, contact MassHealth's Privacy and Security Office, in writing at:

MassHealth Privacy Office
Attn: Martha Young
MassHealth Privacy Office
One Ashburton Place, Room 1109
Boston, MA 02108

You may also file a complaint with the U.S. Secretary of Health and Human Services at: Filing a complaint or exercising your rights will not affect your MassHealth benefits.