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Click ‘Get Form’ to open the psi form mass 2013 in the editor.
Begin by filling out Section 1 with the name of the MassHealth applicant or member. Ensure that you print clearly for easy readability.
In Section 2, check the boxes corresponding to the information you wish to share. This could include eligibility notices or specific claims information.
Proceed to Section 3 and list the name of one person or organization with whom you want to share this information. Remember, only one entity can be named here.
Complete Section 4 by explaining why you want your information shared. If left blank, it will be assumed that sharing is at your request.
In Section 5, provide your address, telephone number, and date of birth. If applicable, include your MassHealth ID number.
Finally, sign and date the form in Section 6 to authorize sharing of your information.
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The amount MassHealth pays to the plan is also known as the premium payment or capitation rate. The premium payment or capitation rate may be more or less than the actual cost of services the member received. A members estate will never have to repay more than the amount MassHealth paid.
What is a MassHealth casualty recovery unit?
MassHealth Casualty Recovery Unit is a department or unit within the MassHealth program in Massachusetts that is responsible for coordinating the recovery of financial resources from third parties for medical expenses incurred by MassHealth members as a result of an accident, injury, or illness.
Do you have to pay back MassHealth benefits?
If you own a home and are approved for MassHealth benefits, MassHealth will place a lifetime lien on the property. MassHealth will later recover its contribution to your (or your loved ones) care upon the sale of the property while you or they are alive, or from the estate upon their death.
Does MassHealth put a lien on your house?
Mason (SJC-13439, December 13, 2023), the Supreme Judicial Court (SJC) holds that the Massachusetts Uniform Probate Code (MUPC) three-year time limit on MassHealth estate recovery claims may not be applied retroactively. However, its lifetime lien on the former home of a MassHealth beneficiary ends at death.
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