How to Complete and Submit Your MassHealth Eligibility Review Form

If a blue envelope from MassHealth arrived in your mailbox, the MassHealth eligibility review form inside is what keeps your coverage active for another year. Fill it out, attach proof of income and any other requested documents, and return it by the deadline printed on the notice — typically 45 days from the date MassHealth sent it. You can submit online through your MA Login account, by mail, by fax, or in person at a MassHealth Enrollment Center.

Why You Received the Form

MassHealth is required to review every member’s eligibility at least once every 12 months under 130 CMR 516.007. The agency first tries to confirm your information automatically by cross-checking records with the Social Security Administration, the Department of Revenue, and other sources. When that data match works, your coverage renews without any action on your part.¹

You got the form because the automatic match couldn’t confirm something. Not receiving a blue envelope isn’t a bad sign; it usually means the state already renewed you. You can check your status any time by signing into your MA Login account or calling the MassHealth Customer Service Center at (800) 841-2900.²

What’s Inside the Blue Envelope

The envelope holds three items: a renewal notice with your specific deadline, an insert explaining the process, and the paper form itself. For members under 65 who don’t face an asset test, the form is usually pre-populated with the information MassHealth had on file the last time it confirmed your eligibility. Your job is to check the pre-filled details, correct anything that has changed, and return the form before the deadline.¹

If the form arrived blank, MassHealth needs a full update on your household. Either way, the standard window is 45 days from the date the request was sent, and a termination notice follows 14 days after that if you don’t respond.¹

Lost the packet? Call (800) 841-2900 (TDD/TTY: 711), Monday through Friday, 8 a.m. to 5 p.m., for a replacement. Members under 65 can also complete the whole thing online through MA Login.²

What to Gather Before You Fill It Out

Having your documents ready before you sit down with the form prevents delays and follow-up requests. MassHealth’s Acceptable Verifications List spells out exactly what it will take for each item.

Social Security Numbers and Identity

You need a Social Security number for every person on the form. Proof can be a Social Security card, a benefit statement showing the full number, a letter from Social Security, or a tax form displaying the number.³

Income

Income is where most mistakes happen. MassHealth uses gross income — the amount before taxes and deductions — not the net figure that hits your bank account. Wage earners should send pay stubs dated within the last 60 days. If your hours or earnings vary, submit several stubs so the agency can average them. A federal Form 1040 with all schedules, W-2s, and 1099s also works, as does a Department of Unemployment Assistance statement showing gross weekly benefits.³

Self-Employment Income

If you or anyone in the household is self-employed or does gig work like rideshare or delivery, use MassHealth’s separate Verification of Self-Employment Income form. It asks for your business name, the type of work, whether income is seasonal, and a month-by-month breakdown of gross income, business expenses, and net income. Each self-employed household member fills out a separate copy.⁴

One trap: paying yourself a salary from your business is not a deductible expense. Only real operating costs count. MassHealth points to IRS Publication 334, Chapter 8, for what qualifies. You sign this form under penalty of perjury, so keep the numbers honest.⁴

Citizenship or Immigration Status

Every household member needs proof. Accepted documents include a U.S. passport, Certificate of Naturalization, Permanent Resident Card, Employment Authorization Document, refugee travel document, or I-94 Arrival/Departure Record. If your document is expired or isn’t on the standard list, send what you have; eligibility staff review everything to determine the best benefit available to you.³

Other Health Insurance

The form asks whether any household member has access to other coverage, such as an employer plan. Listing these helps MassHealth decide whether it pays as primary or secondary insurer on your claims. Have the insurer name, policy number, and the names of covered members ready.

Household Composition

List every person living at your address, regardless of age, and note each person’s relationship to the head of household. Household size drives the Federal Poverty Level calculation MassHealth uses to determine eligibility and coverage type.⁵

Assets, If Anyone Is 65 or Older

An asset test applies when anyone on the form is 65 or older. For 2026, the limit is $2,000 for an individual and $3,000 for a married couple living in the community. Medicare Savings Programs have had no asset limit since March 2024, and that policy continues into 2026. Members under 65 whose eligibility is based on income alone generally do not face an asset test at all.⁶

How to Submit the Form

The fastest route for members under 65 is online through your MA Login account at mahix.org. The portal lets you upload documents and gives you an immediate confirmation number. If you don’t already have an account, use the link in your renewal notice to create one, or call (844) 365-1841 for setup help.²

To mail your form and documents, send them to:

Health Insurance Processing Center
P.O. Box 4405
Taunton, MA 02780²

Photocopy everything before it goes in the envelope. You’ll want that record if anything gets lost or MassHealth asks a follow-up question. Fax is also an option; the current fax number is on your renewal notice. Don’t mail your paperwork to a MassHealth Enrollment Center. Those offices help members in person but aren’t processing centers for mailed forms.⁷

For hands-on help, the seven Enrollment Centers are in Charlestown, Chelsea, Springfield, Taunton, Tewksbury, Quincy, and Worcester. Staff can review your packet before it’s scanned into the system.⁷

After You Submit

MassHealth processes the form and mails an Eligibility Notice with one of three results: your coverage renews at the same level, your coverage type changes to reflect your updated circumstances, or your coverage ends because you no longer qualify.¹

If something is missing, you’ll get a Request for Information notice asking for specific documents within a short window. Treat this as a second deadline. Ignoring it can lead to termination even though you returned the original form on time.

You can track the status of your renewal through your MA Login account or by calling (800) 841-2900 between 8 a.m. and 5 p.m., Monday through Friday.⁸

If You Miss the 45-Day Deadline

A missed deadline isn’t automatically permanent. Once the deadline passes, MassHealth mails a termination notice and coverage ends 14 days later. But the regulations build in a 30-day grace period: if you turn in the completed form within 30 days of the termination date, MassHealth makes a second eligibility determination within 15 days. If you still qualify, coverage can be reinstated retroactively to the termination date, closing the gap entirely.¹

Many people lose coverage they could have kept because they assume the termination is final. It isn’t, for another 30 days.

If MassHealth Says You No Longer Qualify

Losing MassHealth because your income now exceeds the limits opens a 60-day special enrollment period through the Massachusetts Health Connector. You can pick a subsidized ConnectorCare plan or a Qualified Health Plan without waiting for open enrollment. The 60 days run from the date your MassHealth coverage ends.⁹

Appealing a Decision You Disagree With

If MassHealth reduces, changes, or terminates your coverage and you believe the determination is wrong, you can request a fair hearing. The Board of Hearings must receive your completed, signed Fair Hearing Request Form within 60 calendar days of the date you received the notice. Filing options include mail, fax, phone, email, and in person at 100 Hancock St., 6th Floor, Quincy.¹⁰

Timing matters for keeping coverage during the appeal. If the Board receives your request before the action takes effect, your current benefits continue while the appeal is pending. If the action has already been implemented, benefits can still be reinstated, but only if the Board receives your request within 10 days of the mailing date on the termination or reduction notice. Continued benefits are subject to recoupment if the hearing officer rules against you.¹¹

1
Legal Information Institute. Massachusetts Code 130 CMR 516-007 – Continuing Eligibility
2
Mass.gov. Renew Your MassHealth Coverage
3
Mass.gov. MassHealth and Health Connector Acceptable Verifications List
4
Mass.gov. Verification of Self-Employment Income
5
Legal Information Institute. Massachusetts Code 130 CMR 506-007 – Calculation of Financial Eligibility
6
Mass.gov. Program Financial Guidelines for Certain MassHealth Applicants and Members
7
Mass.gov. MassHealth Enrollment Centers
8
Mass.gov. Contact MassHealth – Information for Members
9
Massachusetts Health Connector. Special Enrollment Period
10
Mass.gov. How to Appeal a MassHealth Decision
11
Legal Information Institute. Massachusetts Code 130 CMR 610-036 – Continuation of Benefits Pending Appeal