Application for Benefits

(A) Filing an Application (1) Application. To apply for MassHealth (a) for a person living in the community, the person or their authorized representative must file a complete paper Senior Application and all required supplements or apply in person at a MassHealth Enrollment Center (MEC); or (b) for a person in need of long-term-care services in a nursing facility, the person or their authorized representative must file a complete paper Senior Application and all required supplements or apply in person at a MEC. (2) Date of Application (a) The date of application is the date the application is received by the MassHealth agency. (b) An application is considered complete if it complies with 130 CMR 516.001(C). (c) If an applicant described in 130 CMR 519.002(A)(1) has been denied SSI in the 30- day period before the date of application for MassHealth, the date of application for MassHealth is the date the person applied for SSI. (3) Paper Applications or In-person Applications at the MassHealth Enrollment Center (MEC)—Missing or Inconsistent Information (a) If an application is received at a MEC or MassHealth outreach site and the applicant did not answer all required questions on the Senior Application, or if the Senior Application is unsigned, the MassHealth agency is unable to determine the applicant’s eligibility for MassHealth. (b) The MassHealth agency requests responses to all of the unanswered questions necessary to determine eligibility. The MassHealth agency must receive such information within 15 days of the date of the request for the information. (c) If responses to all unanswered questions necessary to determine eligibility are received within 15 days of the date of the request referred to in 130 CMR 516.001(A)(3)(b), the MassHealth agency will request any corroborative information necessary to determine eligibility, as provided in 130 CMR 516.001(B) and (C). (d) If responses to all unanswered questions necessary for determining eligibility are not received within the 15-day period referred to in 130 CMR 516.001(A)(3)(b), the MassHealth agency notifies the applicant that it is unable to determine eligibility. The date that the incomplete application was received will not be used in any subsequent eligibility determinations. If the required response is received after the 15-day period, the eligibility process commences and the application is considered submitted on the date the response is received, provided that if the required response is submitted more than one year after the initial incomplete application, a new application must be completed. (e) Inconsistent answers are treated as unanswered. (B) Corroborative Information. The MassHealth agency requests all corroborative information necessary to determine eligibility. (1) The MassHealth agency sends the applicant written notification requesting the corroborative information generally within five days of receipt of the application. (2) The notice advises the applicant that the requested information must be received within 30 days of the date of the request and of the consequences of failure to provide the information. (C) Receipt of Corroborative Information. If the requested information, with the exception of verification of citizenship, identity, and immigration status, is received within 30 days of the date of the request, the application is considered complete. The MassHealth agency will determine the coverage type providing the most comprehensive medical benefits for which the applicant is eligible. If such information is not received within 30 days of the date of the request, MassHealth benefits may be denied.