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How to Appeal a MassHealth Decision

September 14, 2021

MassHealth applicants and members or someone authorized to act on their behalf have a right to appeal an action taken by MassHealth if they disagree with the decision, including a modification or denial of a prior authorization (PA) and premium assistance.

How to Request a Fair Hearing

Hearings can be requested by mailing or e-faxing a Fair Hearing Request Form to the Office of Medicaid, Board of Hearings or by calling MassHealth Customer Service.

The Board of Hearings must receive a completed, signed request within 30 calendar days from the date the individual received the notice of MassHealth’s decision. Additionally, individuals may retain their existing benefit if the hearing form is received either before the benefit changes/ends or within 10 calendar days from the mailing date of the MassHealth notice, whichever is later.

Reminder: Assister Role in the Appeals Process

Certified Application Counselors (CACs) can, upon members’ request, provide information about the appeal process, help members locate a request for fair hearing form (enclosed with the notice and also available online), and explain to members how to complete the form. CACs cannot and should not, in their sole capacity as CACs, decide whether to appeal a case, sign the fair hearing request form, or act as an appeal representative, for a member.

Navigators can, assist consumers in completing an appeal request. Navigators should not attend or represent consumers at the appeal.

Learn more about how to appeal a MassHealth decision here.