Medicaid Recertification will Start Again on April 1, 2023
Already a member of our Senior Care Options (HMO-SNP) plan? Use the link below to access member resources such as plan documents and forms!
Beginning April 1, 2023, MassHealth will begin their standard renewal process for all
MassHealth members. You will need to take action to maintain your coverage.
Watch your mail for info from MassHealth regarding the renewal of your coverage
MassHealth will resume their standard renewal process for all MassHealth members starting
April 1, 2023. The renewal process is how the state confirms that people still qualify for
MassHealth coverage. Renewals usually occur every year, but they were paused during the
federal COVID-19 public health emergency.
MassHealth expects the process to take about a year. So, you may hear from MassHealth
about your renewal anytime between April 2023 and April 2024. To learn more about this
process go to https://www.mass.gov/masshealth-eligibility-redeterminations.
“Redetermination” is the process MassHealth uses to make sure that current MassHealth
members are still eligible for MassHealth. Federal law requires MassHealth to regularly check
eligibility. This ‘check’ is generally called an “annual review” if you are 65 or older.
- Call MassHealth at 800-841-2900 (TTY: 711) Monday – Friday, 8 a.m. – 5 p.m.
- Visit the MassHealth Website
Here’s what you can do now to ensure you continue to receive coverage through MassHealth
and get the best benefits you qualify for:
- Make sure MassHealth has up-to-date contact information for you by calling MassHealth at 800-841-2900 (TTY: 711). This includes your address, especially if you have moved in the last two to three years, phone number and email address. MassHealth will send your renewal packet and other information about your eligibility by mail, so it is important that they have your current address.
- Let MassHealth know about any changes to your income, disability status or family size. You should report changes to your information as soon as possible, but no later than 10 days from the date of the change. This includes any change to your income, address, phone number, family size, disability, job, or other health insurance.
- Read all mail MassHealth sends you. If you get a blue envelope from MassHealth, you will need to act by a specific date to keep your current coverage. This date will be part of the information you receive.
When it’s time for MassHealth to review your eligibility, they will look through federal and state
data sources to see if you still qualify for MassHealth. Here’s what may happen next:
If MassHealth is able to confirm that you are still eligible, they may renew you
automatically. If they do, they will send you a letter confirming your MassHealth coverage has
been renewed. If you get this type of letter, you don’t need to do anything.
If MassHealth cannot verify your information electronically (auto-renew), they will send
you a large blue envelope (pictured below) that includes a letter and a renewal application.
Inside of each blue envelope members will find the following:
- The renewal notice, including the renewal deadline
- An insert about renewal
- A paper renewal form
Here’s a checklist to help you complete your application:
- Take action by the deadline listed in the letter
- Complete your renewal application in one of the following ways:
- Mail or Fax – Complete, update and sign the application. Then follow the directions on the form to mail it to MassHealth. Or you can fax it to MassHealth at (857) 323-8300.
- Schedule an In-Person Appointment with the Enrollment Center – Use the MassHealth online scheduling tool to get in-person help with your application. You can schedule an appointment here.
- Hand deliver your completed renewal form in person at a MassHealth Enrollment Centers. Visit the website for location information: MassHealth Enrollment Centers (MECs)
- Get Help from Local Resources – Help from an Enrollment Assister is free for everyone. Enrollment Assisters, such as Navigators and Certified Application Counselors (CACs), are trained and certified individuals at organizations in your area. They can help you apply for coverage, shop for plans, answer your questions about your eligibility, payments, plan details, and health care reform rules and requirements. You can go to https://my.mahealthconnector.org/enrollment-assisters to find the nearest CAC.
- Submit it Online – Complete and submit your application online if you have an e- Submission number. To submit your application online, you will need a code, which is found on the second page of the renewal notice. If you cannot find your code, you can make an in-person or virtual appointment with the enrollment center, or contact MassHealth at (800) 841-2900 (TTY: 711), and a representative can look up your code.
- MassHealth will review your application. If they need additional documents from you, they will send you a request for information (RFI). The request for information will be mailed to you in a white envelope. You have an additional 90 days to respond to that request for information. Check your mail often after submitting your renewal application to make sure you don’t miss this notice. You will need to submit the necessary documents by the stated deadline.
- To confirm you are still eligible for health care coverage, MassHealth may ask for documents such as:
- Confirmation of a change of address
- New social security numbers (SSNs) for people applying
- Federal tax returns, if you file
- Changes in health coverage offered
- Changes to immigration or citizenship status
- Pay stubs or employer statements
- If you need help filling out the application, be sure to rely on trusted sources, such as:
- MassHealth by calling 800-841-2900 (TTY: 711)
- Enrollment assisters (EAs) listed on the MassHealth website
- A financial counselor or EA at your provider’s office.
- The MassHealth Enrollment Centers (MECs) are open for limited walk-in appointments. We strongly encourage you to use MassHealth’s new appointment scheduler if you need help from a MassHealth Customer Service Representative. Monday through Friday, 8:45 a.m.-5 p.m.
- Check your mail. MassHealth will send you a letter telling you if your coverage was renewed.
Note: Never share your personal data or documents with people who are not trusted sources. EAs will never ask you to pay for helping you complete your application.
- If you have lost your renewal form, you can download a new Renewal Application for Health Coverage for Seniors and People Needing Long-Term-Care Services.
- You can call MassHealth Customer Service at (800) 841-2900, TDD/TTY: 711 and use the self-service option to find out if you need to submit a renewal form and when the renewal form is due.
- Make sure to submit before the deadline to ensure you do not have a lapse in coverage.
During this time period, you may receive other important mail from MassHealth that you
must read and respond to in order to maintain your coverage and understand what
benefits you qualify for.
This other mail will arrive in white envelope separately from the Blue Envelope containing the
renewal. The return address may indicate “Commonwealth of Massachusetts” or a specific unit
of the Commonwealth, such as the Health Insurance Processing Center or EDMC. You should
watch out for any mail that could be from MassHealth, and open all envelopes.
Other important mail may include:
- Requests for Information
- Requests for Verification
- Automatic Renewal Notices (No Action Needed)
- Premium Bills
- Adult or Child Disability Supplements
- Approval Letters
- Termination Letters
- Denial Letters
- Other documentation not related to renewals, including prior authorization notices, etc.
When MassHealth renews your eligibility, your Tufts Health Plan Senior Care Options (HMO SNP) or Tufts Health Plan Senior Care Options CW (HMO SNP) coverage will continue. You do not have to take action to keep your Tufts Health Plan coverage.
You may have a gap in coverage if you did not respond to a review, or because MassHealth
needs your most updated information. You can provide this information in one of the following
ways. You have at least 14 days after receiving a termination notice before your benefits
- If you are no longer eligible for MassHealth, you may qualify for subsidized ConnectorCare plans or other subsidies to help you pay for a health plan on the Massachusetts Health Connector. Visit https://www.mahealthconnector.org/ or call customer service at 1-877- MA ENROLL (TDD/TTY: 1- 877-623-7773) to learn more or enroll in a plan.
- Fill out and submit a new SACA-2 Paper Application – Fill out and submit the Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2) if it has been over a year since you updated your information or submitted your application to MassHealth.
- Get Help from an Enrollment Assister – Help from an Enrollment Assister is free for everyone. Enrollment Assisters, such as Navigators and Certified Application Counselors (CACs), are trained and certified individuals at organizations in your area. They can help you apply for coverage, shop for plans, answer your questions about your eligibility, payments, plan details, and health care reform rules and requirements. You can go to https://my.mahealthconnector.org/enrollment-assisters to find the nearest CAC.
- Visit MassHealth – Visit a MassHealth Enrollment Center (MEC). The MECs are open for limited walk-in appointments. You can also schedule a phone or video appointment with MassHealth. We strongly encourage you to use MassHealth’s new appointment scheduler if you need help from a MassHealth Customer Service Representative. Find the nearest MassHealth Enrollment Center (MECs)
- If you are employed or have a spouse who is employed explore whether you can get Employer Sponsored Insurance through their job or be added to your spouse’s employer sponsored insurance policy. If you do have access to Employer Sponsored Insurance, losing your MassHealth coverage is considered a Qualifying Life Event (QLE) that will allow you to enroll outside of the Open Enrollment period.
- You may also contact Tufts Health Plan. We offer a variety of Medicare Plans and can help identify one for which you may be eligible. Call 1-855-670-5934 (TTY: 711) to speak to a representative. Representatives are available 8 a.m.–8 p.m., 7 days a week (Mon– Fri. from Apr. 1–Sept.30).
Don’t share your personal information or give money to anyone saying you have to pay them to keep your MassHealth coverage or apply for other coverage. The Health Connector, assister organizations, and MassHealth will never threaten you or anyone in your household or ask for your credit card information or payment. Report it if someone calls, emails, or texts you and:
- Asks for your personal information (like your Social Security Number)
- Asks for money (like credit card payment, gift cards, cash, prepaid debit card, or cryptocurrency)
- Threatens you or anyone in your household with legal action
If any of these situations occur, report it to MassHealth by calling 800-841-2900 (TDD/TTY: 711), contact the Federal Trade Commission and contact your local police department.