By following the steps below, you may help to speed up your clients' eligibility determination process:
- Include language requesting that your client's eligibility determination be "EXPEDITED FOR MEDICAL NECESSITY" on the MassHealth paper application or on the fax cover page accompanying the application.
- Contact MassHealth approximately 2-4 weeks after the application has been submitted if your client has not received a MassHealth determination or a request for additional information. This call provides another opportunity to request that the determination be EXPEDITED FOR MEDICAL NECESSITY.
- Remind your clients that it is important to open their mail and follow up on any requests for information which are time-sensitive. Failure to submit additional information in time may result in an application review being canceled and a client needing to re-submit a new application.
- Place a follow-up call to MassHealth with your client approximately 1-2 weeks after any additional documents are submitted to confirm that the documents were received and are being processed.
- If your client has not received a determination letter within 6-8 weeks from the initial date of application submission, contact MassHealth with your client to follow-up on their application status.
Please remember that HDAP (HIV Drug Assistance Program) clients who do not have active MassHealth or an active ConnectorCare plan are required to submit a MassHealth determination annually (NOTE:
HDAP clients who are age 65 and older and have already received a denial from MassHealth for "income and assets" do not need to reapply annually). HDAP's recertification reminder letter should indicate if a client is due to submit a new MassHealth determination. HDAP may be able to accept the first and last page of a recently submitted MassHealth application to grant temporary HDAP approval pending a MassHealth determination.
Please feel free to call HDAP or BRIDGE staff at 617-502-1700 if you have any questions.