State Resources

AGENCIES
APPLICATIONS, FORMS AND WAIVERS
JOB AIDS AND TALKING POINTS
TRAININGS
SAMPLE NOTICES AND MEMBER COMMUNICATION
REGULATIONS AND POLICIES

AGENCIES

APPLICATIONS, FORMS AND WAIVERS

Mail/Fax Cover Sheet (May 2020)
Navigator IDP Fax Sheet
CAC IDP Fax Sheet
Special Enrollment Period Form [English]
Special Enrollment Period Form [Spanish]
Fillable ACA-3 [English] (March 2022)
Fillable ACA-3 [Spanish] (July 2021)
SACA-2 [English] (March 2022) Fillable
S ACA-2 [Spanish] (July 2021) Fillable
SACA-2 ERV [English] (July 2021) Fillable
SACA-2 ERV [Spanish] (July 2021) Fillable
Fillable Additional Person(s) English ACA-3 (March 2022)
Fillable Additional Person(s) Spanish ACA-3 (July 2021)
MassHealth Buy-In English (March 2022)
MassHealth Buy-In Spanish (January 2022)
Residency Affidavit [English]
Residency Affidavit [Spanish]
Zero Income Affidavit [English]
Zero Income Affidavit [Spanish]
Incarceration Affidavit [English]
Incarceration Affidavit [Spanish]
Job Update Form [English]
Jon Update Form [Spanish]
Additional Information about Your Access to ESI (October 2018)
Non-Custodial Parent Form [English]
Non-Custodial Parent Form [Spanish]
MassHealth Adult Disability Supplement [English]
MassHealth Adult Disability Supplement [Spanish]
MassHealth Child Disability Supplement [English]
MassHealth Child Disability Supplement [Spanish]
MassHealth Medical Release Form [English]
MassHealth Medical Release Form [Spanish]
MassHealth Premium Hardship Waiver Form (07/22)
MassHealth Third Party Liability Indicator Form
MassHealth Buy-In Fillable [English] (July 2021)
MassHealth Buy-In Fillable [Spanish] (March 2021)
MassHealth Notice of Birth (NOB)
2019 Office of Patient Protection Open Enrollment Waiver Form
Letter For Tax Preparer [Spanish]
Third Party Liability Indicator
Long Term Care Checklist

JOB AIDS AND TALKING POINTS

Job Aids:

Open Enrollment 2023
- Open Enrollment Talking Points
- ConnectorCare No Cost Medications
- Assister Webinar Schedule
- Subsidized Prelminary Eligibility Notice
- Unsubsidized Preliminary Eligibility Notice
- ConnectorCare 2022 and 2023 Premium Comparison
Release 25.0 Job Aid
Release 24.0 Job Aid
Categories of Afghan Immigration Statuses
Open Enrollment 2022
- OE22 Talking Points
- Consumer Guide to Subsidies 2022
- ConnectorCare Shopping Guide in English
- ConnectorCare Shopping Guide in Spanish
- QHP Shopping Guide in English
- QHP Shopping Guide in Spanish
- ConnectorCare Carrier Lookup for 2022
- ConnectorCare Overview 2022
- Webinar Schedule
- Health Connector Health Plans Summary 2022
- Open Enrollment 2022 Training Scenarios
- Preliminary Subsidized Sample Notice 2022
- Preliminary Unsubsidized Sample Notice 2022
MassHealth Eligibility Updates May 2021
Assister Job Aid: Helping someone newly enrolled in Medicare OE21
Open Enrollment 2021
- Health Connector Standardized Plan Design 2021
- ConnectorCare Enrollee Contributions 2021
- ConnectorCare Benefits & Copays 2021
Updates to Minimum Essential Coverage (August 2020)
Health Reimbursement Arrangements (August 2020)
System Update 21 (August 2020)
MassHealth Eligibility Flexibility Overview (June 2020)
Where Can I Send Documents (May 2020)
Assister Guidance
DOI Bulletin on Coronavirus
Optum ID changing to MA Login
Tax Filing Options
2019 Tax Preparer Letter
2019 Tax Preparer Letter Spanish
Assister Guide – Voter Registration
Where Can I send Documents Fact Sheet
Open Enrollment 2020
- ConnectorCare 2020 Enrollee Contributions
- ConnectorCare 2020 Benefit and Copay Chart
- QHP 2020 Standardized Plan Design
- Mixed Household Sample Notice
- Preliminary Renewal Sample Notice – ConnectorCare to Unsub
- Final Renewal Sample Notice
- Health Connector Renewal Insert
- ConnectorCare Overview 2020
- Guide to Subsidies – Spanish
- Guide to Subsidies – English
- QHP Shopping Guide – Spanish
- QHP Shopping Guide – English
- ConnectorCare Shopping Guide – Spanish
- ConnectorCare Shopping Guide – English
- Tufts- Atrius Talking Points
Release 18.0 Job Aid
Release 17.0 Job Aid
CAC 2019 Certification FAQs
Tax Forms and Reconciliation 2019
Open Enrollment 2019:
- Connector Open Enrollment Call Schedule
- ConnectorCare Shopping Guide in English
- ConnectorCare Shopping Guide in Spanish
- 2019 ConnectorCare Overview
- QHP Shopping Guide in English
- QHP Shopping Guide in Spanish
- Consumer Guide to Subsidies in English
- Consumer Guide to Subsidies in Spanish
- Health Connector Health and Dental Plans 2019
- Qualified Health Plan Design for 2019
- ConnectorCare benefits and Co-pays
- ConnectorCare Enrollee Contributions by Region 2019
- Preliminary Eligibility Notice
- Eligibility and Renewal Notice
- Health Connector Redeterminations and Renewal Overview
- Helping Consumers Troubleshoot Connector Coverage
- Individual Mandate Consumer Guide
- Individual Mandate Key Points
- Health Connector Free Tax Preparation Information
- Health Connector Renewal and Shopping Insert
- Open Enrollment Poster (English)
- Open Enrollment Poster (Spanish)
New MassHealth Plan Options:
- Continuity of Care FAQ
- Continuity of Care Memo
- Continuity of Care – Additional Member Supports
- MassHealth Health Plan Directory Tool (3/2019)
- MassHealth Health Plan Provider Directory Desk Guide
- ACO One-Pager (English)
- ACO One-Pager (Spanish)
- MassHealth Enrollment Guide (English)
- MassHealth Enrollment Guide (Spanish)
- ACO Notices At-a-Glance (An Assister Guide)
- ACO Letter A – ACO Partnership Plan Model (English)
- ACO Letter A – ACO Partnership Plan Model (Spanish)
- ACO Letter B – Primary Care ACO Model (English)
- ACO Letter B – Primary Care ACO Model (Spanish)
- ACO Letter C – MCO Administered ACO Model (English)
- ACO Letter C – MCO Administered ACO Model (Spanish)
- Letter AE – Auto-Assigned (English)
- Letter AE – Auto Assigned (Spanish)
- Letter PSP – Plan Selection Period (English)
- Letter PSP – Plan Selection Period (Spanish)
- Learn, Compare, Enroll Worksheet (English)
- Learn, Compare, Enroll Worksheet (Spanish)
- Enrollment Event Flyer (English)
- Enrollment Event Flyer (Spanish)
Job Aid: Helping Someone Newly Enrolled in Medicare
SHIP FAQ
Job Aid: HIX Release 16.0
Job Aid: HIX Release 12.0
Job Aid: HIX Release 11.0
MassHealth MCO Plan Selection & Fixed Enrollment Period FAQ
FAQ for Transitioning Care when Switiching Health Plans
CAC 2017 Recertification FAQ
Assister FAQ for Open Enrollment 2017
Open Enrollment 2017 Fact Sheet
Enabling Protocols in Browsers
Job Aid: HIX 9.0 Release
Job Aid: HIX 8.1 Release
Job Aid: RFI Generation/Experation Rules
Job Aid: Reporting Multiple MassHealth ID
MassHealth 2016 Renewal Guides (FAQ, Training Materials, and Sample Notices)
2016 – Assister Issue Reporting Form
2016 – Navigator Consumer Reporting Form
System Release 7.2
Job Aid: Account Linking for Assisters
Job Aid: Shopping for Pediatric Dental Plans
Auto Renewal Process
Job Aid: EFT Portal
Job Aid: Health Connector Payment Portal Tips
Health Connector Applying and Shopping (11/2/2015)
Release 7.0: Application Updates, Shopping Improvements & Provider Search
Job Aid: Release 7.0
HIX Updates – Release 6.0 (July 17, 2015)
Electronic Funds Transfer (Updated 7/15)
Multi-Household Shopping Job Aid
Income Guide
System Issues Log (Updated 11/21)
Informational Support Guide
ACA-3 Missing Critical Data (MCD) Guide
Job Aid: ACA-3 Missing Critical Data (MCD)
Required and Optional Forms for Assisters
Where to Send Documents or Verification Information Tip Sheet (Updated 1/13)

Talking Points for Assisters:

TRAININGS

ACA Learning Series:

MTF Meetings

SUMMER 2022
- MassHealth Updates
- Intro to HSN
- MA Health Care Learning Series
- Medicare/SHINE
SPRING 2022
- MassHealth and Health Safety Net Updates
- MA Health Care Learning Series
- Provider Updates
WINTER 2022
- MassHealth and Health Safety Net Updates
- Health Connector Updates
- Integrated Care Overview
- Provider Updates
SPRING 2021
- Health Safety Net and MassHealth Updates
- Health Connector Updates
- Provider Services
WINTER 2021
- MassHealth Presentation
  - Recorded presentation
- Health Connector Updates
  - Recorded presentation
- Health Safety Net Update
- Medicare Updates
- Provider Services
OCTOBER 2020
- MassHealth Updates
- Health Connector Updates
- Health Safety Net Updates
- Medicare Updates
- SNAP Overview
- Provider Updates
JULY 2020
- MassHealth Updates
- Health Connector Updates
- Health Safety Net Updates
- Medicare Updates
- Provider Updates
APRIL 2020
- MassHealth and Health Connector COVID-19 Updates
- MassHealth Updates
- HSN COVID-19 Updates
- Health Connector Updates
JANUARY 2020
- Health Safety Net Updates
- MassHealth Updates
- Culture Connects
- MA Health Care Learning Series
  - Tax Filing Options Aid
  - Tax Preparer Letter – English
  - Tax Preparer Letter – Spanish
  - Glossary
- Health Connector Updates
- Premium Assistance
OCTOBER 2019
- Health Safety Net Updates
- MassHealth Updates
- MassHealth Health Plan Updates Y3
  - Important News About Your MassHealth Health Plan (Yr3)
- Health Connector Updates
  - ConnectorCare Enrollee Contribution Map 2020
- Public Charge and Health Benefits
- New Medicare Beneficiaries
  - Health Connector Assister Job Aid: Helping Someone Newly Enrolled in Medicare
JULY 2019
- Health Safety Net Updates
- MassHealth Updates
- SHINE and Prescription Advantage Presentation
- MA Health Care Learning Series
- WIC 101
- Provider Updates
APRIL 2019
- Health Safety Net Updates
- MA Health Care Learning Series
- MassHealth Updates
- MassHealth Disability Training
- SNAP Training – DTA
- SNAP Training – UMASS
JANUARY 2019
- Health Safety Net Updates
- MassHealth Updates
- MA Health Care Learning Series
- MassHealth Provider Services Update
- The Basics of SSI & SSDI and Work
OCTOBER 2018
- Health Safety Net Updates
- MassHealth and Assister Updates
- MA Health Care Learning Series
- MassHealth Provider Services Updates
- Medicare Open Enrollment Session
JULY 2018
- Health Safety Net Updates
- MassHealth Provider Services Updates
- MassHealth Updates
- MA Health Care Learning Series
- Options Counseling
APRIL 2018
- Health Safety Net Updates
- MassHealth Updates
- MA Health Care Learning Series
- MassHealth Provider Services Updates
JANUARY 2018
- Health Safety Net Updates
- MassHealth Provider Services Updates
- MassHealth Updates
- MA Health Care Learning Series
OCTOBER 2017
- Health Safety Net Updates
- MassHealth Provider Services Updates
- MassHealth Updates
- MA Health Care Learning Series
- Assister Updates
JULY 2017
- MassHealth Updates
- Health Safety Net
- MassHealth Provider Services Updates
- MA Health Care Learning Series
- SHINE
APRIL 2017
- MassHealth Updates
- MA Health Care Learning Series
- Health Safety Net Updates
- MassHealth Provider Services Updates
- MassHealth Premium Assistance
JANUARY 2017
- MassHealth Updates
- MassHealth Provider Services Updates
- Health Safety Net
- MA Health Care Learning Series
- Assister Updates

SAMPLE NOTICES AND MEMBER COMMUNICATION

Sample Notices:

Member Communication:

REGULATIONS AND POLICIES

JOIN IN THE LOOP MASSACHUSETTS

Join the conversation