How to Fill Out the SACA-2: MassHealth Application for Seniors

To fill out the SACA-2, the MassHealth Application for Health Coverage for Seniors and People Needing Long-Term-Care Services, assemble your identity, income, and asset documents first, then complete the form’s parallel Member 1 and Member 2 columns section by section: personal information, existing insurance, income sources, countable assets, authorized representative if any, third-party liability, and signatures. Both spouses can apply on a single filing. Mail or fax the completed form with copies of every supporting document to the MassHealth Central Processing Unit in Charlestown, and the state has 45 days to decide.

Before You Fill Anything In: Confirm This Is Your Form

The SACA-2 is specifically for Massachusetts residents aged 65 or older who do not have a minor child in the household, and for people of any age who need long-term-care services, whether in a nursing facility or chronic hospital or through a home- and community-based services waiver. If you are 65 or older but a parent or caretaker relative of a child under 19 living with you, use the standard MassHealth application instead.¹

Documents to Have in Front of You

The form asks for detailed financial and personal information, and MassHealth cross-references what you report against tax records and financial databases. Pull everything together before you start writing so you are not hunting for a statement mid-form.

Social Security numbers for everyone on the application, proof of Massachusetts residency such as a utility bill, lease, or bank statement showing a Massachusetts address, and immigration documentation for anyone who is not a U.S. citizen.
Income records: Social Security benefit statements, pension award letters, annuity statements, rental income records, and documentation of veteran payments. MassHealth uses gross monthly income.
Current statements for all checking and savings accounts, held individually or jointly, plus certificates for stocks, bonds, and mutual funds.
Life insurance policy documents showing both face value and current cash surrender value. Term policies with no cash value still have to be listed.
Deeds for any real estate, including your primary residence.
Medicare card numbers and any private health insurance details, since MassHealth pays only what other insurers do not.
Records of any asset transfers in the past five years — gifts, trust transfers, or sales below market value. These will be reviewed, and disclosing them is far safer than having MassHealth find them.

Confirm your finances fall within the limits before you file. For 2026, a single individual aged 65 or older can have monthly income up to $2,982 and no more than $2,000 in countable assets. Countable assets include bank accounts, investments, and the cash surrender value of life insurance. Your primary home is generally exempt while you or your spouse lives there, along with one vehicle, personal belongings, and household furnishings. When a married applicant needs nursing facility care and the other spouse remains at home, the community spouse can keep up to $162,660 in assets for 2026.²

Working Through the Form

Download the current version of the SACA-2 from mass.gov or pick one up at a MassHealth Enrollment Center.¹ The form has parallel columns for Member 1 and Member 2 so a married couple can apply together on one filing. If only one person is applying, leave the Member 2 columns blank.

Personal Information

The opening sections collect name, date of birth, Social Security number, address, and citizenship or immigration status for each applicant. These are straightforward if you have your documents in hand.

Existing Health Insurance

Enter your Medicare number and any private carrier details, including policy numbers. MassHealth is the payer of last resort and coordinates with other coverage, so accuracy here prevents billing problems later.

Income

List every source with its monthly amount. Report gross figures before deductions. Social Security, pensions, annuity distributions, rental income, and veteran payments all belong here. Certain medical expenses and health insurance premiums may be subtracted during the eligibility calculation, but you report the gross first.

Assets

This is where most of the form’s complexity lives, and where mistakes most often slow the process. Bank account balances should match your most recent statement. For life insurance, the form asks separately about face value and cash surrender value — these are different numbers, and entering the wrong one in the wrong field is a common error. For real estate, give the property address and estimated market value. Report everything; omissions create delays or denials when verification turns up the missing items.

Authorized Representative

If a family member, social worker, or attorney is handling the application, that person completes the Authorized Representative section, provides their contact information, and signs their own portion. This authorizes MassHealth to discuss the case with them.

Third-Party Liability

Disclose any recent injury or accident that could involve another party’s insurance, such as a car accident or workplace injury. MassHealth coordinates benefits with auto insurers, workers’ compensation, and liability carriers. Pending claims still get listed.

Signatures

The applicant signs and dates the form; a spouse applying jointly signs as well. An unsigned application is returned without processing. If the applicant cannot sign because of a physical or cognitive limitation, the authorized representative signs on their behalf.

Watch Out for the Five-Year Look-Back

Any application that includes long-term-care coverage triggers a review of every asset transfer you made in the 60 months before the application date. Gifts to children or grandchildren, property moved into an irrevocable trust, and sales to family members below market value all get flagged, and each flagged transfer produces a penalty period during which MassHealth will not pay for nursing facility care. Limited exceptions exist for transfers to a spouse, a blind or disabled child, or certain trusts for a disabled individual under 65, but they are narrow and need proper documentation.

The practical point for filling out the form: list these transfers completely in the financial disclosure sections. MassHealth has access to the records that would reveal them, and an omission discovered during verification is worse than a transfer disclosed up front.

Submitting the Form

Attach copies of all supporting documents, never originals, and send the package by one of these methods:

Mail to Central Processing Unit, P.O. Box 290794, Charlestown, MA 02129. Certified mail gives you proof of the date sent, which becomes your application date.³
Fax to (617) 887-8799, using the MassHealth mail/fax cover sheet from mass.gov as the first page.³
Online, using the fillable version of the SACA-2. The form must be completed in a single session; there is no save-and-return feature.
In person at a MassHealth Enrollment Center, which can help you complete the application. Do not mail or fax the application to an Enrollment Center address, as the centers do not process applications.⁴

Note that the mailing address differs from the one used for standard MassHealth applications, which trips people up.

After You Send It

Federal rules give MassHealth 45 calendar days to make an eligibility determination, or 90 days if the decision involves a disability determination.⁵ The clock runs from the point MassHealth has everything it needs, which is why incomplete applications stretch out.

During review, you may receive a Request for Information notice asking for missing documents or clarification. Respond within the stated deadline. Miss it and the application can be denied automatically, forcing you to start over. When the review is finished, you get a written determination explaining the result, the coverage type, and the start date.

Keep copies of everything you send and everything you receive. If a dispute arises about what was submitted or when, your copies are the only proof you will have.

Getting Help

Between the asset disclosure, the look-back review, and the income calculations, many families work with a MassHealth-approved Certified Application Counselor or an elder law attorney. MassHealth Enrollment Centers around the state offer free in-person help and will confirm your supporting documents are complete before you submit.⁴