If your Massachusetts Medicaid (MassHealth) coverage was denied, reduced, or terminated, you can appeal and request a fair hearing, and often keep your benefits while the case is pending. The deadline to request a hearing in Massachusetts is 60 calendar days from the date you received the notice, shorter than the federal maximum of 90 days.

In This Guide

What you can appeal in Massachusetts Medicaid

Federal law guarantees every Medicaid applicant and member the right to a fair hearing before the state agency when a claim for assistance is denied, is not acted on promptly, or is subject to an adverse determination. In Massachusetts, that right runs through MassHealth and the Office of Medicaid, Board of Hearings.

A MassHealth applicant or member who disagrees with a MassHealth decision has a right to appeal. That covers:

  • A denial of an application for coverage
  • A termination of existing coverage or assistance
  • A reduction or restriction of assistance, including a cut to service hours
  • A prior authorization that was denied or modified
  • A managed care contractor's denial, reduction, or termination of a service

Each of these is an appealable action, and the appeal goes to the Board of Hearings.

Massachusetts Medicaid appeal deadlines that decide your case

Three deadlines matter in a Massachusetts Medicaid appeal, and they are not the same number.

The request window is 60 calendar days. The Board of Hearings must receive your completed, signed fair hearing request within 60 calendar days from the date you received the notice of the MassHealth agency's action. Federal law caps this deadline at a maximum of 90 days from the date the notice is mailed, and Massachusetts sets its own window at 60 days within that ceiling. Read the deadline off your own notice and do not assume you have the full 90 days.

The continuation window closes earlier, before the action takes effect. To keep your benefits during the appeal, your request has to reach the Board of Hearings before the implementation date of the action, which is earlier than the 60-day filing deadline.

The managed care window is 120 days after the plan's final decision. If your denial came from a managed care contractor, you first complete the plan's internal appeal, then the Board of Hearings must receive your fair hearing request within 120 days after you receive the plan's final internal appeal decision. Federal managed care rules require the state to allow between 90 and 120 days for that request, and Massachusetts sets it at the top of that band.

One more deadline protects renewals. If your coverage was terminated only because a renewal form was not returned in time, federal law requires the agency to reconsider your eligibility without a new application if you submit that form within 90 days of the termination date. That duty covers eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Massachusetts may offer the same window but is not required to, so ask MassHealth.

How to keep your benefits during the appeal

Keeping your benefits during the appeal is not automatic. In Massachusetts, whether your assistance continues turns on timing.

Your assistance continues until the Board of Hearings decides your appeal if the Board receives your initial fair hearing request before the implementation date of the appealable action. This mirrors the federal continuation rule, under which services keep flowing when you request the hearing before the date the action takes effect. The trigger is the implementation date printed on your notice, not a flat count of days.

If the action was already implemented before you filed, your assistance is reinstated when the Board of Hearings receives the fair hearing request within 10 days of the mailing of the notice of the appealable action. That reinstatement is a separate, after-the-fact remedy, not the earlier continuation trigger.

If your assistance continues and the hearing decision goes against you, the action is implemented immediately once the decision is rendered. Continuation keeps your coverage in place through the appeal, but it does not guarantee the outcome.

Managed care (MCO) appeals: exhaust the plan first

MassHealth is a managed care program. Most members are enrolled in an Accountable Care Organization (ACO), a Managed Care Organization (MCO), or, for seniors and dual-eligible members, a Senior Care Organization (SCO) or One Care integrated plan. When a plan denies care, the appeal runs through the plan before it reaches a state fair hearing. A Managed Care Organization is a private health plan that MassHealth pays to administer a member's benefits.

You must exhaust the plan's internal appeal first. A member appealing a managed care contractor's action must exhaust all remedies available through the contractor's internal appeals process before requesting a fair hearing, except where the contractor notifies the member that exhaustion is unnecessary. Skipping the internal appeal and going straight to the Board of Hearings will get the fair hearing request dismissed.

The internal appeal runs on the federal managed care timeline. You have 60 calendar days from the date on the plan's adverse benefit determination notice to file the internal appeal, which can be requested orally or in writing. That notice must tell you how to appeal, how to request an expedited appeal, and how to ask that your benefits continue. The plan must resolve a standard appeal within 30 calendar days and an expedited appeal within 72 hours, with a possible extension of up to 14 calendar days. Request the expedited track whenever waiting on the standard timeline could seriously jeopardize your health.

Only after the plan's decision does the state fair hearing open. After the plan issues a final internal appeal decision that is wholly or partly against you, the Board of Hearings must receive your fair hearing request within 120 days of the date you received that decision.

How to request a fair hearing in Massachusetts

Massachusetts routes every Medicaid fair hearing through the Office of Medicaid, Board of Hearings (BOH). You request a hearing by completing the MassHealth Fair Hearing Request Form and submitting it one of these ways:

  • By mail: Office of Medicaid, Board of Hearings, 100 Hancock St., 6th Floor, Quincy, MA 02171
  • By fax: (617) 887-8797
  • By email: boh-fairhearingsrequest@mass.gov (send it password-protected)
  • In person: at the Board of Hearings office in Quincy
  • By phone: through the MassHealth Customer Service Center at (800) 841-2900

You can also reach the Board of Hearings directly at (617) 847-1200 or toll-free at (800) 655-0338. After you submit your appeal, the Board of Hearings sends you notice of the hearing date, time, and place at least 10 calendar days before your scheduled hearing. Keep a copy of everything you send and note the date you mail or fax it, because the 60-day clock is measured against the date the Board receives your request.

Frequently Asked Questions

When does the 60-day appeal clock start?

The 60 calendar days run from the date you received the MassHealth notice of action, and the Board of Hearings measures the deadline against the date it receives your request, not the date you send it. Mail or fax the request early and keep proof of when you sent it, because a request that arrives after day 60 can be dismissed even if you mailed it in time. The federal ceiling is 90 days, but Massachusetts uses the shorter 60-day window.

What is the difference between keeping my benefits and having them reinstated?

Keeping your benefits means your assistance never stops: it continues until the Board of Hearings decides your appeal, provided the Board receives your request before the implementation date of the action. Reinstatement is the fallback when the action has already taken effect, restoring your assistance if the Board receives your request within 10 days of the date the notice was mailed. Either way, if the final decision goes against you, the action takes effect once the Board renders its decision.

Do I need a lawyer for a Massachusetts Medicaid fair hearing?

No. You can represent yourself, bring a family member, or have an advocate or attorney speak for you. Representation often helps for service reductions, prior authorization disputes, and long-term-care eligibility, where a physician's documentation and the governing rules carry the case. The Board of Hearings can be reached at (617) 847-1200 for questions about the process.

What if my denial came from my managed care plan instead of MassHealth?

A Managed Care Organization (MCO), Accountable Care Organization (ACO), Senior Care Organization (SCO), or One Care plan denial follows a two-step path. You must exhaust the plan's internal appeal first, unless the plan tells you that exhaustion is unnecessary. You have 60 days from the plan's determination notice to file that internal appeal. Only after the plan's final decision can you request a Board of Hearings fair hearing, within 120 days of that decision.

Learn More

MedicaidHow to Appeal a Medicaid DenialDenied Medicaid? You can appeal, and one deadline decides whether your benefits keep flowing during the appeal. Know your fair-hearing rights and act fast. MedicaidMassachusetts Medicaid: The Complete GuideMassachusetts Medicaid (MassHealth) explained: 1634 + medically-needy state, $2,000 asset limit, $72.80 PNA, 50% spousal share, Chapter 197 estate recovery. MedicaidHow to Apply for MassHealthHow to apply for MassHealth (Massachusetts Medicaid) in 2026: the online route for people under 65 and the SACA-2 application for seniors and long-term care. MedicaidMassHealth SCO and One Care PlansMassachusetts Medicaid SCO and One Care changed on 1/1/2026: SCO now requires Medicare Part A and B, and One Care moved to a D-SNP platform. Plans and steps. MedicaidMassachusetts Medicaid Estate RecoveryMassachusetts Medicaid estate recovery in 2026: the 2024 LTC Act narrowing, the $25,000 auto-waiver, three hardship waiver categories, and probate-only scope.

Find personalized help navigating a Massachusetts Medicaid appeal at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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