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Click ‘Get Form’ to open the MassHealth Eligibility Review for Nursing Facility Services in the editor.
Begin with Section I: Member Information. Fill in your name and social security number, and indicate if you are a U.S. citizen or national.
Proceed to Section II: Income Information. List all sources of income, providing monthly amounts before deductions, except for social security income.
In Section III: Asset Information, detail your assets including bank accounts and real estate. Ensure to provide proof of ownership and current values.
Complete Section IV: Spouse/Dependent Information if applicable, listing names and relationships.
Fill out Section V: Health Insurance Information by listing all health insurance policies you hold, excluding Medicare or MassHealth.
Finally, review Section VI: Signature. Read the statements carefully before signing and dating the form at the bottom.

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What is MassHealth redetermination?

If you decide to apply for MassHealth, you must give MassHealth proof of all assets that are available to you and your spouse as of the date of application for MassHealth. You must also give MassHealth proof of all resources (income and assets) transferred generally within the last 60 months.

What is the eligibility review form for MassHealth?

(effective March 1, 2025), The general income limits for seniors (age 65+) and adults with disabilities seeking MassHealth Standard coverage while living in the community are approximately: Single Person: $1,255 per month. Married Couple: $1,704 per month (for the couple together)

What is the monthly income limit for MassHealth?

Redetermination Process. To verify a members continued eligibility for MassHealth, the redetermination process includes three steps. First, members eligibility is verified from available income data and state program information like SNAP.