The application for MassHealth is called the Medical Benefit Request (MBR). There are three ways to get the MassHealth application form and information booklet:

By mail:

Call the MassHealth Enrollment Center at 1-888-665-9993 (TTY: 1-888-665-9997 for the deaf and hard of hearing). They will send you a MassHealth information booklet, application form, and any supplements you might need. They will also answer any questions you have about applying for MassHealth.

You may also call one of the regional MassHealth Enrollment Centers:

Revere: 1-800-322-1448 (TTY: 1-877-668-4499)
MassHealth Enrollment Center
300 Ocean Avenue, Suite 4000
Revere, MA 02151
Springfield: 1-800-332-5545 (TTY: 1-800-596-1276)
MassHealth Enrollment Center
333 Bridge Street
Springfield, MA 01103
Taunton: 1-800-242-1340 (TTY: 1-800-596-1272)
MassHealth Enrollment Center
21 Spring Street, Suite 4
Taunton, MA 02780
Tewksbury: 1-800-408-1253 (TTY: 1-800-231-5698)
MassHealth Enrollment Center
367 East Street
Tewksbury, MA 01876

Online:

Get a MassHealth application and information booklet from the MassHealth web site: MassHealth Applications and Member Forms. You will need Adobe Reader to view or print the forms on this site.

There are separate Medical Benefit Request (MBR) applications for:

People under age 65:
MBR English
MBR Spanish
People 65 or older, or anyone needing long-term care:
Senior MBR English
Senior MBR Spanish
Note: Also use this form if one spouse is under 65 and the other is 65 or older
People on Medicare applying for MassHealth Buy-In:
Buy-In Application English
Buy-In Application Spanish

In person:

Visit your local community health center (CHC), hospital, or other community organization that has been approved to submit MassHealth applications. A MassHealth benefits advisor will answer your questions, fill out an online application with you, and submit your application via computer.

To find a community health center near you, call the Massachusetts League of Community Health Centers Patient Referral Line at 1-800-475-8455 or use the League's Find a Health Center search tool.

Note: The MassHealth application is also the application for the Children's Medical Security Plan (CMSP), Commonwealth Care, Healthy Start, and the Health Safety Net (Free Care). If you are approved, you will be given the best coverage for which you are eligible.

Where do I send the application?

If you are mailing your application, send it to the MassHealth Enrollment Center listed on the application. Make sure you answer all the questions, then sign and date the form, and send it in.

If there are questions that do not apply to you, enter N/A (not applicable). Make sure the information you give about yourself and your family is correct and complete.

Can someone else apply for me?

If you are not able to apply for MassHealth yourself, you can choose a family member, friend, or other person to apply for you. This person is your "eligibility representative." You must file an Eligibility Representative Designation Form with MassHealth to give permission for this person to help you.

If the person applying for MassHealth is not able to sign the form, a spouse, adult child, or other responsible person can sign the form instead. You do not need to file this form to apply for children under 18.

What documentation do I need?

Read the instructions that come with the Medical Benefits Request (MBR) to see which documents you have to send in with your application. You will need some of the following proofs:

Proof of identity
Proof of citizenship for U.S. citizens and nationals
Proof of immigration status for noncitizens (copy of green card or other official immigration papers)
Birth dates for all family members
Social Security number (Note: This is not needed for MassHealth Limited.)
Proof of disability determination
Proof of wages (two recent wage stubs, copy of tax return, or letter from your employer)
Proof of self-employment, business, or rental income (copy of tax return)
Proof of unearned income (TAFDC, SSI, child support, pensions, Social Security)
Bank statements
Copy of health insurance card for applicants with health insurance
Proof of medical condition for people applying based on HIV/AIDS status
Certificate of blindness for people applying based on blindness

If you need help getting your proofs or have questions about the application, call MassHealth Customer Service at 1-888-665-9993.

Note: To find out how to get a copy of your birth certificate, see Where to write for vital records on the National Center for Health Statistics web site.

Can I get information in other languages?

MassHealth information and forms are available in many languages. MassHealth also offers translation services over the phone. Call the MassHealth Enrollment Center at 1-888-665-9993 or TTY: 1-888-665-9997 or go to one of the Massachusetts community health centers to get help in another language.

How long does it take to get MassHealth?

If you are not disabled, MassHealth must make a decision on your eligibility within 45 days if your application is complete. If MassHealth needs more information or proofs from you, they will usually notify you within 5 days of receiving your application. You will have 30 days to send in your information.

If you apply for MassHealth as disabled, the process will take longer, but not more than 90 days. You must submit a Disability Supplement along with the regular MassHealth application.

You can check the status of your application by calling the MassHealth Enrollment Center at 1-888-665-9993 (TTY: 1-888-665-9997).

Note: If you need medical care right away, let MassHealth know this. In some cases you can get a temporary MassHealth card and receive care while your application is being processed. Women who are pregnant can get prenatal care while they wait for MassHealth approval (see MassHealth Prenatal).

What changes do I have to report?

You must report any changes that might affect your eligibility for MassHealth within 10 days, or as soon as possible. Examples of the types of changes you must report are: a change in income, immigration status, disability, family size, or health insurance.

In addition, MassHealth will review your eligibility every twelve months, or possibly more often. You must return your review form and any proofs that MassHealth requires by the deadline listed on the form, or you might lose your MassHealth coverage.

What should I do if I am denied MassHealth?

If you are denied MassHealth, you have the right to ask for a fair hearing and appeal the decision. MassHealth will provide you with printed information on how to ask for a hearing and how much time you have to ask for a hearing. You can also contact:

Board of Hearings
2 Boylston Street
Boston, MA 02116
Telephone: 1-617-210-5800
Fax: 617-210-5820

If you need legal help with your appeal, you should contact Health Law Advocates or Legal Services.

You must give written permission if you want MassHealth to discuss your information with someone else. You must fill out the Permission to Share Information Form and send it to the MassHealth Enrollment Center. The address is listed on the form.