When MassHealth denies your application for benefits, it’s easy to feel discouraged. But a denial isn’t the end of the road. You have the right to appeal—and in many cases, a second look can lead to approval. We’ve helped many individuals and families through this process, and we know that a clear, well-prepared appeal can make a big difference.
Common Reasons MassHealth Applications Get Denied
There are several reasons why MassHealth might deny an application. Sometimes, it’s as simple as a missing document. Other times, it may come down to financial eligibility or medical information that wasn’t submitted in the correct format. A few common causes include:
- Incomplete or missing documentation
- Assets or income over allowable limits
- Lack of clear evidence showing medical eligibility
- Errors made during the online or paper application process
- Outdated or mismatched personal information
The denial letter you receive will usually explain the reason for the decision. Don’t ignore it—this letter is the starting point for your appeal.
Step 1: Review Your Denial Notice
The first thing you should do is read the denial notice carefully. It may include multiple reasons for the decision, a summary of the information MassHealth reviewed, and most importantly, the deadline for filing your appeal.
This deadline matters. In most cases, you must request a hearing within 30 days of the date on the denial notice. If you miss that window, your appeal rights may be affected.
Gather everything you submitted with your original application, and keep it in a safe place. You may need to review or resubmit certain documents during the appeal process.
Step 2: File an Appeal
To appeal a MassHealth decision, you must file a Request for a Fair Hearing. You can do this online, by mail, or by fax. The request should include:
- Your full name and contact information
- Your MassHealth ID or case number
- A short statement explaining why you disagree with the decision
- A copy of the denial notice, if available
The Office of Medicaid Board of Hearings handles these requests. As long as your appeal is filed within the deadline, you will receive a notice confirming your hearing date and details.
Step 3: Prepare for the Hearing
The hearing is your opportunity to explain your side and present any missing or updated information. You’ll want to gather everything you can to support your case, including:
- Updated medical records or provider letters
- Proof of income or bank statements
- Any documents that were missing from your original application
- A timeline of communication or documents submitted
If someone helps care for you, such as a family member or health aide, consider having them join the hearing to offer support or testimony. Be clear, respectful, and prepared to answer questions.
Strategies That Can Help Strengthen Your Appeal
Taking time to organize your materials can make a big difference. Here are a few strategies we often recommend:
- Review your original application for errors or omissions
- Submit updated documents showing your current financial or medical status
- Include letters from doctors or care providers that explain your condition
- Clarify any misunderstandings that may have affected your eligibility
We also encourage people to ask for help. Having someone on your side who understands how MassHealth works can give you peace of mind and help you present a stronger case.
After the Hearing: What to Expect
Once the hearing is complete, the hearing officer will review your file and issue a decision. This can take several weeks. The decision may:
- Approve your application
- Uphold the denial
- Send the case back to MassHealth for further review
If the decision still isn’t in your favor, there may be additional appeal options available, including judicial review. But many appeals are resolved successfully at this stage.
Help With Your Appeal
MassHealth appeals can feel confusing and frustrating, especially when time is tight and paperwork piles up. We’re here to help guide you through it. From reviewing your denial letter to preparing for the hearing, we work with you every step of the way.
If you’ve received a denial from MassHealth, don’t wait. Contact Surprenant, Beneski & Nunes, P.C. today. We’ll review your situation and help you take the next steps toward getting the benefits you deserve.