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.
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How to appeal a MassHealth decision
Contacts
Office of Medicaid, Board of Hearings
MassHealth Customer Service Center
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.
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.
If you have a disability and need an accommodation in order to attend or participate in your hearing, you can send us a Request for Reasonable Accommodation form to get the accommodation you need.
The Board of Hearings must receive your completed, signed request within 60 calendar days from the date you received the notice of the MassHealth agency’s action.
How to appeal How to appeal a MassHealth decision
- Fill out the Fair Hearing Request Form.
- Make a copy for yourself. Include the MassHealth notice you are appealing.
- 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.
- Include the MassHealth notice you are appealing.
To file an appeal by telephone, you may call the MassHealth Customer Service Center at (800) 841-2900, TDD/TTY: 711.
Self-service is available 24 hours per day in English and Spanish. Other services are available Monday through Friday, 8 a.m.– 5 p.m. Interpreter service is available. Please do not call the Board of Hearings to file a fair hearing request.
You can file an appeal in person between the hours of 8:45 and 4:45 at the following location:
Office of Medicaid, Board of Hearings
100 Hancock Street, 6th Floor
Quincy, MA 02171
You must bring the MassHealth notice you received with you. Your appeal will then be filed and processed. A hearing will be scheduled in the ordinary course.
- Fill out the Fair Hearing Request Form
- Include the MassHealth notice you are appealing
- E-Mail your request for a Fair Hearing to boh-fairhearingsrequest@mass.gov, with both the completed form and notice attached to the e-mail.
If you wish to e-mail us your request for a fair hearing, we recommend you do so via encrypted e-mail to protect your privacy. Unencrypted e-mails are not secure and could be intercepted and read by a third party.
Next steps for How to appeal a MassHealth decision
To ask for a copy of your record, follow the steps below:
- Fill out the Fair Hearing Request Form. You can find this form by going to MassHealth Member Forms.
- After you send the form, a worker from MassHealth will call you about your appeal and your records. If you have an authorized representative, they will call that person. Let the worker know which records you want.
- MassHealth will send your records to you before the appeal.
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.
The Board of Hearings is committed to providing meaningful access for all users, including users with disabilities. If you have a disability, you can request a reasonable accommodation to give you better access to the Board of Hearings by sending us a Request for Reasonable Accommodation form.
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, 66.29 KB,
Fair Hearing Request Form
(English, PDF 66.29 KB)
Open DOCX file, 31.1 KB,
Fair Hearing Request Form
(English, DOCX 31.1 KB)
Open PDF file, 81.71 KB,
Fair Hearing Request Form (Large Print)
(English, PDF 81.71 KB)
Open PDF file, 988.13 KB,
Board of Hearings Request for Reasonable Accommodation
(English, PDF 988.13 KB)
Open DOCX file, 14.26 KB,
Board of Hearings Request for Reasonable Accommodation
(English, DOCX 14.26 KB)
Open PDF file, 57.41 KB,
Board of Hearings Request for Reasonable Accommodation (Large Print)
(English, PDF 57.41 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.
Related
- Office of Medicaid Board of Hearings Case Decisions
- 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
- MassHealth Eligibility Record Request