Court Rules MassHealth Notices Must Be More Specific

The Suffolk County Superior Court has ruled against MassHealth and its standard form used for issuing denials. The court ruled that MassHealth denial notices, in their present form, do not provide a clear statement of the specific reasons supporting an agency decision.

In the current process, after a MassHealth application is filed by an applicant seeking long-term care eligibility, MassHealth typically responds within 45 days with an “Information Request” which requires the applicant to submit more information, documentation and explanations about financial activity. Even when an applicant complies with this request, MassHealth will often issue a vague denial. Once the denial is issued, an elder law attorney will file an appeal with the Board of Hearings to determine what, if any, verifications are still outstanding. The entire hearing process can drag on for months in unnecessary delay, causing the applicant undue anxiety as to the outcome of their application for long-term care, and, can cause clients to incur additional attorney’s fees.

As a result of the court’s ruling, MassHealth will now have to issue a specific reason for denying an application, which will allow MassHealth applicants and their attorneys to be better prepared to challenge a MassHealth denial at the time of a fair hearing. This will result in a more fair and efficient process, and allow for more timely resolutions of MassHealth applications.