Pursuant to 956 CMR 3.18, the Commonwealth Health Insurance Connector Authority (the “Connector”) is issuing this administrative information bulletin (“Bulletin”) to clarify procedures for the Commonwealth Care Health Insurance Program (“Commonwealth Care”). The Bulletin covers procedures to (a) enroll in Commonwealth Care; (b) request a change of health plans; (c) request a waiver or reduction of premiums or a waiver of copayments because of a claim of extreme financial hardship; and (d) bring an appeal under 956 CMR 3.14 to challenge decisions relating to Commonwealth Care. Complete with forms.

Link to applications and forms section of MassHealth website includes application forms and supplements, member book, enrollment guide, adult and child disability supplements, eligibility representative forms etc. All forms in English and Spanish

HIPAA-compliant release form required to obtain information from Office of Medicaid about someone other than yourself or person for whom you are an eligibility representative

Link to application form for seniors and those needing long term care on MassHealth website

The Office of Medicaid has revised the form to be used to request a record of Massachusetts birth from the Vital Statistics Office. The birth record will be sent back to the Office of Medicaid not the applicant. An applicant born in Mass. who needs a copy of the birth certificates can obtain it at no charge from the Vital Stats. Office but not by using this form.

Application for all non-institutionalized MassHealth applicants under age 65.