Massachusetts: Health

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MassHealth Fair Hearing Request Form to appeal a MassHealth Decision

If you disagree with a decision made by MassHealth about your coverage, benefits, or eligibility, this interview can help you request a Fair Hearing.

You can use this interview to appeal decisions such as a denial of MassHealth coverage, a determination that you are not eligible, or a reduction or termination of benefits. For example, you may use this form if MassHealth stops covering a medication or service that your provider says you still need.

After you submit your hearing request, the Office of Medicaid, Board of Hearings will review your request and schedule a hearing. At the hearing, you will have the opportunity to explain why you disagree with MassHealth’s decision and provide any supporting information.

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