Sign up for an email notification if new membership forms or updated membership forms are published on the website. Note: If you click on the login link, an empty email should be displayed. If your settings prevent this, you can also copy join-masshealth-member-forms@listserv.state.ma.us and paste into your address line. Just send the empty email as it is addressed. No text is required in the body of the text or in the subject line. This form is used to inform MassHealth of a new job or a change in your job. A form for applicants and members who were born in Massachusetts and need help proving their U.S. citizenship. A form used by members who wish to request a fair hearing and who are enrolled in a managed care plan, a care manague organization, the primary care clinic`s public health program (CPC) or a senior care organization. A form used to determine the amount of a person`s wealth if that person wants to know if they are eligible for long-term Care from MassHealth. A form used by members to make a direct deposit with the State Treasurer.

A form for adults applying for MassHealth because of their disability. This document contains five copies of the medical records publication form. No pledge will be placed on the property if the masshealth recipient indicates on the registration that he does not intend to return home. The property is then counted as an asset for the purposes of the masshealth authorization. However, their value is ignored for up to 9 months, provided the beneficiary signs an agreement to sell the property at fair value. A form used by applicants and members who wish to request a fair hearing. A form used by candidates and members to obtain free bank registrations for MassHealth. A form used when a candidate or member wants MassHealth to pass on their personal information to someone other than their agent. A form for people who need personal assistance. A form containing complete information on acceptable proof of us/national citizenship status and identity. A form used with MADS-A and MADS-C to obtain medical information from a health care provider so massHealth can make a disability decision.

Do not provide confidential information such as Social Security or bank account numbers. In the absence of a request to object to the validity of the right, in the event of non-recovery or postponement of the recovery within 60 days, payment is expected in full. If appropriate documentation is provided to prove that the estate does not contain sufficient assets to pay the full debt, the Estate Recovery Unit accepts less than the total amount of the claim. In such cases, the Estate Recovery Unit will request wealth information to determine the value of all assets held by the fraudster.