How to Fill Out the Mass Health Eligibility Review Form

MassHealth is a comprehensive health insurance provider for needy children and adults in the state of Massachusetts. In order to retain medical benefits from MassHealth, it is required that those enrolled annually complete the Eligibility Review Form. This form confirms that the financial and medical circumstances that qualified the participant for benefits continue to exist. Below are instructions for completing the MassHealth Eligibility Review form so that benefits can continue without interruption.

Things You'll Need

• Eligibility Review Form (mailed to you from MassHealth annually)
• Proof of income and assets
• Immigration cards (if not a U.S. citizen)
• Health insurance premium bills

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Instructions

• 1

  Obtain a MassHealth Eligibility Review form. These are mailed to you from MassHealth annually, or more frequently if a significant change has taken place (i.e. you have turned 65 years of age or have entered a long-term care facility).

• 2

  Respond to each question on the form using the financial documents for reference. These questions primarily address changes in your financial situation since the previous review.

• 3

  Submit the form and any requested accompanying documentation within 30 days of its receipt.