Navigating the complexities of the Medicaid (MassHealth) application process
Our Medicaid Application Process
Whether applying for Medicaid for in-home care through PACE (Program of All-Inclusive Care for the Elderly) or for a nursing home stay, the process requires extensive personal information and multiple steps, with timelines that vary by client and urgency.
The following are the major steps in the Medicaid application process.
1
Pre-filing: Gather and review financials
We collect your financial statements for all accounts for the past five years, along with other required supporting documents. We then analyze the records for transactions of $1,000 or more in or out of any account, because MassHealth will ask about them once we file. At the same time, we update your asset worksheet, determine eligibility strategies, and establish a target filing date.
2
File the application with MassHealth
In Massachusetts, MassHealth processes all Medicaid applications. Once we complete and submit your application, it is processed by a central intake/processing unit and then assigned to a MassHealth caseworker.
3
Caseworker review and “Request for Information” (RFI)
After the caseworker reviews the application, they typically issue an RFI requesting updated statements and/or explanations. We’ll compile and submit the requested items by the deadline; however, additional RFIs may follow.
4
Decision: Approval or denial
Once MassHealth has what it needs, an approval or denial is issued. Denials may be procedural or technical and do not necessarily indicate ineligibility.
5
If denied: Appeal and hearing
We’ll file a fair hearing request within the required timeframe and participate in the telephone hearing process. Many denials can be resolved through clarification and supplemental documentation, sometimes avoiding a full hearing.
6
Post-approval: Maintaining eligibility
We review with you the ongoing compliance steps required to maintain your benefits, including keeping countable assets within limits. We encourage you to call if you are having trouble with this so we can walk you through what needs to happen to protect your assets as well as your Medicaid benefits.
MassHealth may conduct periodic or annual eligibility reviews, which we can also assist you with if your program or provider does not handle them.
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Beverly, MA 01915