Massachusetts Medicaid Office

MassHealth office

MassHealth provides health benefits and help paying for them to qualifying children, families, seniors, and people with disabilities living in Massachusetts. The program may offer benefits directly or pay all or part of a household's other health insurance premiums. As a member, you may have access to doctor visits, dental, prescription drugs, behavioral health services, and other important health care services.

How to reach MassHealth

• MassHealth Customer Service Center — (800) 841-2900, with TDD/TTY at 711 for people who are deaf, hard of hearing, or speech disabled. Representatives are available Monday through Friday from 8 a.m. to 5 p.m.
• Online portal — sign in to an MA Login account at login.mahix.org for self-service tasks, including renewals and reporting changes.
• Schedule an appointment — book a time with a MassHealth representative via the agency's appointment scheduler.
• Agency website — mass.gov/orgs/masshealth for member and applicant resources, publications, and regulations.
• Office address — 100 Hancock St., 1st Floor, Quincy, MA 02171.

MassHealth posts active alerts when federal Medicaid policy changes. A current notice flags changes that include new work or education requirements — known as community engagement requirements — and more frequent eligibility checks for certain MassHealth members, plus changes that affect which immigrants qualify. Members should keep contact information current so any change notices reach them; updates can be reported through the same MA Login account that handles applications and renewals.

Who qualifies for MassHealth?

MassHealth provides health and dental care benefits to individuals and families, including people with disabilities. When you apply, MassHealth decides which of six coverage types fits your household based on income, citizenship or immigration status, age, and special circumstances. The agency commits to giving every approved applicant the most complete coverage that they can get. You must be a Massachusetts resident to receive any of these services.

The six MassHealth coverage types

• Standard — the most complete benefit package, available to eligible children, pregnant individuals, parents and caretaker relatives, adults with disabilities, and certain other groups. Standard covers Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for members under 21.
• CommonHealth — similar benefits to Standard, available to certain adults and children with disabilities who cannot get Standard. Children under 21 enrolled in CommonHealth also receive EPSDT (with some copayments).
• CarePlus — a broad range of health care benefits for adults who are not otherwise eligible for Standard. People who are "medically frail" — for example, with a medical, mental health, or addiction condition that limits work or school, or who need help with daily activities — may be able to move to Standard for more benefits.
• Family Assistance — for Massachusetts residents who are not eligible for Standard. Covers inpatient and outpatient services, mental health and addiction, home health, developmental screens, shots, emergency-only ambulance, and smoking cessation.
• Premium Assistance — when you have, or have access to, other health insurance, MassHealth may pay all or part of your household's premiums when that is the more cost-effective option.
• Limited — emergency-only services for people whose immigration status keeps them from receiving more services.

Children with serious mental health needs

MassHealth offers behavioral health services for eligible children and youth under 21 who are enrolled in MassHealth Standard or MassHealth CommonHealth. A child who is not eligible for Standard but whose behavioral health evaluation shows significant mental health needs or a serious emotional disturbance may be eligible for CommonHealth.

Disability, pregnancy, and noncitizen pathways

Members who think they may qualify on the basis of disability can apply through the agency's "Applying for disability with MassHealth" path. MassHealth also publishes information specifically for pregnant members and for noncitizens, plus accessibility resources for applicants and members with disabilities. Free language assistance is available throughout the application and member processes.

MassHealth income limits

MassHealth does not publish a single side-by-side income chart on its consumer landing pages. Instead, each application — the Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3) — routes the household into one of six coverage types based on the rules for each. MassHealth determines which program or coverage type you can get and gives you the most complete coverage that you can get.

What determines your coverage type

• Household income
• Citizenship or immigration status
• Age
• Special circumstances — for example, pregnancy, a disability evaluation, or access to employer-sponsored insurance

Where to find the published financial guidelines

MassHealth publishes detailed "Program financial guidelines for certain MassHealth applicants and members" on mass.gov. The document covers income standards and any applicable resource rules by program. Because the figures update with federal poverty guidelines and state policy changes, the current version on mass.gov is the authoritative source — verify there before relying on a specific number.

If you have other insurance available

If you have, or have access to, other health insurance, MassHealth Premium Assistance may pay all or part of your household's premiums when that's the more cost-effective coverage option. Your ACA-3 application screens for this automatically.

How to apply for MassHealth

MassHealth uses different paths for applicants under 65 and those 65 or older. Both routes lead to the same Massachusetts Application for Health and Dental Coverage and Help Paying Costs — the ACA-3 — and the agency determines which of the six coverage types you qualify for.

If you are under 65: online via MA Login

Create an MA Login Account, which the agency describes as the fastest way to stay connected to your MassHealth or Health Connector coverage. With an MA Login Account you can apply for coverage, renew your coverage, report household changes, and submit requested information. The application is accessible through login.mahix.org for current members and through the Health Connector at mahealthconnector.org/get-started for new applicants.

If you are over 65 or applying for long-term care services

Applicants 65 or older can submit a change, apply for or renew coverage, or send information by mail or fax, or by calling MassHealth Customer Service. A separate application path handles MassHealth coverage for seniors and people of any age who need long-term-care services.

By phone

Call the MassHealth Customer Service Center at (800) 841-2900 (TDD/TTY 711) for help applying, status questions, or to start an application by phone. Representatives staff the line Monday through Friday 8 a.m. to 5 p.m.

Schedule an in-person or virtual appointment

MassHealth offers an appointment scheduler that lets applicants and members book a time with a MassHealth representative for help with the application or with a current case.

Applying for disability

Members who think they may qualify on the basis of disability follow the agency's "Applying for disability with MassHealth" process, which uses additional forms and documentation. The disability path is published on the same mass.gov member page.

Federal decision deadlines

Federal Medicaid rules give the state up to 45 days to decide a non-disability application and up to 90 days when the basis is disability. Retroactive coverage may run up to three months before the application month for qualifying medical bills.

What MassHealth covers

MassHealth benefits vary by coverage type, but the Standard and CommonHealth packages cover the broadest set of services. The benefits below come from the agency's published covered-services lists; copays and limits may apply depending on the service and your coverage type.

What MassHealth Standard and CommonHealth cover

• Inpatient hospital services
• Outpatient services — hospitals, clinics, doctors, dentists, family planning, vision care
• Medical services — lab tests, X-rays, therapies, pharmacy, eyeglasses, hearing aids, medical equipment and supplies
• Adult day health and adult foster care
• Mental health and addiction services, inpatient and outpatient
• Well-child screenings for children under 21 — medical, vision, dental, hearing, mental health and addiction, developmental screens, shots
• Long-term services and supports at home or in a long-term-care facility, including home health
• Transportation services
• Services to help you quit smoking

For disabled adults who also get Medicare Part B, MassHealth pays the Medicare premium and any applicable coinsurance and deductibles.

EPSDT for members under 21

Children, teens, and young adults under 21 who are eligible for MassHealth Standard or CommonHealth also receive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) — all medically necessary services covered under the federal Medicaid law.

CarePlus, Family Assistance, Premium Assistance, and Limited

CarePlus covers a similar slate of medical, mental health, addiction, home health, transportation, and smoking-cessation services for adults who aren't otherwise eligible for Standard. Family Assistance covers a narrower set, including inpatient and outpatient services, mental health and addiction, home health, developmental screens and shots, and emergency-only ambulance. Premium Assistance pays toward other health insurance you already have or can access. Limited covers emergency-only services — inpatient hospital emergency services (including labor and delivery), emergency room visits, certain medical services outside a hospital, pharmacy for emergency conditions, and emergency-only ambulance — for people whose immigration status keeps them from getting more services.

Dental, vision, and non-emergency medical transportation

MassHealth publishes specific pages on dental benefits, vision care services, and Non-Emergency Medical Transportation (NEMT) for members. Coverage details vary by coverage type — the dental and vision pages list which services each coverage type includes.

Long-term-care services

MassHealth offers long-term-care services at either a medical institution or in a member's home through a program known as Home- and Community-based Services Waivers (HCBS). A separate "MassHealth for Seniors and People who need Long-Term-Care Services" portal covers eligibility, coverage types, health plans, and the Senior Guide.

Gender-affirming care

MassHealth publishes a "Gender-affirming care for MassHealth members" resource page describing what's available to members.

Other state Medicaid pages