How to Apply:

The application for MassHealth (formerly the Member Benefit Request or “MBR”) is now called the “Application for Health Coverage and Help Paying Costs.” Applications can be obtained:

» BY PHONE through the MassHealth Enrollment Center at 1-888-665-9993 (TTY: 1-888-665-9997).

They will send you a MassHealth information booklet, application form, and any supplements. They will also answer any questions you have about applying for MassHealth.

» ONLINE at http://www.mass.gov/eohhs/docs/masshealth/membappforms/aca-2-english.pdf.

» IN PERSON at a local community health center, hospital, or other MassHealth-approved community organization. A MassHealth benefits advisor will answer your questions, fill out an online application with you, and submit your application via computer. To find a community health center near you, call the Massachusetts League of Community Health Centers Patient Referral Line at 1-800-475-8455.

To apply and be considered for MassHealth due to a disability, rather than income, either a CHILD DISABILITY SUPPLEMENT or ADULT DISABILITY SUPPLEMENT form must be included with the application.

An AUTHORIZED REPRESENTATIVE DESIGNATION FORM must be submitted to MassHealth when submitting an application or to check on eligibility, status of claims, supplies, etc. on behalf of an adult child (over 18 regardless of ability/disability). This form will allow information to be shared about the adult child. The authorization may need to be renewed periodically.