Massachusetts Masshealth Forms

This form is used for prescription of transportation in Massachusetts.

This Form is used for obtaining authorization to disclose medical information for MassHealth in Massachusetts. (Spanish)

This form is used for requesting a review of the medical necessity of enteral nutrition products for Masshealth beneficiaries in Massachusetts.

This form is used for requesting prior authorization in Massachusetts.

This form is used for assessing assets to determine eligibility for MassHealth (Medicaid) in Massachusetts.

This Form is used for requesting financial information in the state of Massachusetts. It is used to gather specific financial details for investigative or regulatory purposes.

This Form is used for authorizing electronic funds transfer payments in Massachusetts.

This form is used for updating job information in the state of Massachusetts.

This form is used for applying for Long-Term-Care Supplement in Massachusetts.

This form is used for noncustodial parents in Massachusetts who need a large print version of the form.

This form is used for filing a claim for well-child care services in the state of Massachusetts.

This form is used for filing a workers' compensation claim in Massachusetts with a maximum benefit of 5%.

This documento es un formulario en español utilizado en Massachusetts para solicitar una audiencia imparcial.

This document is used for submitting a request for a fair hearing in Massachusetts for the Primary Care Clinician Plan - PCC Plan or Senior Care Option - SCO.

Este formulario se utiliza para solicitar información financiera en Massachusetts.

This Form is used for requesting a fair hearing in Massachusetts. It is in Spanish and is used to request an impartial hearing.

This document is used for updating employment data in Massachusetts. It is a form (Formulario JU-1) that is written in Spanish.

This document is a checklist used for applying for long-term care in Massachusetts. It helps applicants make sure they have all the necessary documents and information before submitting their application.

This type of document is a Supplement for Long Term Care in Massachusetts for Spanish speakers.

This document is for determining the value of assets to determine eligibility for MassHealth in Massachusetts. (Spanish)

This Form is used for authorization to share information in Spanish in Massachusetts.

This Form is used for the Personal-Care-Attendant Supplement in Massachusetts.

This Form is used for supplementing the Personal Care Attendant (PCA) application for individual support in Massachusetts.

This form is used for adults with disabilities to apply for additional benefits under MassHealth in Massachusetts. The form is in Spanish.

This Form is used for filing a routine child care claim in Massachusetts. The document is written in Spanish.

This Form is used for filing a claim for the maximum 5% reimbursement in Massachusetts. (Spanish)

This Form is used to verify residency in Massachusetts.

This Form is used for obtaining citizenship tests for individuals born in Massachusetts who are seeking assistance in the United States.

This form is used for helping individuals born in Massachusetts to obtain proof of U.S. citizenship.

Este formulario se utiliza para verificar el estado de reclusión en Massachusetts mediante una declaración jurada.

This form is used for verifying the incarceration status of an individual in Massachusetts. It is an affidavit that must be completed by the person seeking the verification.

This Form is used for submitting a sworn statement to verify zero income in Massachusetts.

This form is used for individuals in Massachusetts to provide a sworn statement verifying that they have zero income. It is commonly used when applying for social services or government benefits.