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MassHealth Permission to Share Information form (PSI)

Date: 
01/13/2023
Author: 
EOHHS
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This form  gives MassHealth permission to share the information they have about someone with another person or organization. It is also needed to communicate with Disability Evaluation Services.  Click the "Go to Website" link below to download the form in English, Spanish or large print from the MassHealth website.

In Jan 2023 MassHealth released a revised  PSI form. The Eligibility Operations Memo 23-02 says that only the new PSI form will be accepted after Feb 1, 2023.