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MassHealth Application - Overview

To receive MassHealth, a form called a Medical Benefit Request must be completed.

The Medical Benefit Request form is included with the MassHealth booklet in the MassHealth application package. Call a MassHealth Enrollment Center at 1-888-665-9993 (or TTY: 1-888-665-9997 for people who are deaf or hard of hearing) for an application package. Help with filling out the form is also available by calling these numbers. Application packages may also be downloaded from:
http://www.mass.gov/dma/masshealthinfo/appl_mbr.htm

It is important to read the instructions on the cover page of the Medical Benefit Request form before beginning to complete it. The first four pages must be completed and the form must be signed. If any of the attached Medical Benefit Request supplements apply to the individual or to any of his/her family members, they must also be completed and returned with the Medical Benefit Request.

Family members include the individual, his/her spouse, and children under age 19, if all are living together. If neither parent is living in the home, the family group may include children under age 19 and an adult caretaker relative who are all living together. If more than one family lives in the home and wants to apply for MassHealth, each family group needs to fill out a separate form. (See MassHealth family group for definition of family.)

Additional Information

The topic MassHealth Application Procedures has additional details about completing and submitting the MassHealth application.

See also:

MassHealth Eligibility - Family Size

MassHealth - Basic Eligibility Standards


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