You have 60 days to file the appeal. You have about 10 days to keep the hours you have while it is pending. Those are two different deadlines and families miss the short one because the notice does not shout about it.

If you do nothing else today, file the appeal this week.

How do I keep my current hours during the appeal?

Your appeal has to reach the Board of Hearings before the termination or reduction date on the notice, or within 10 days of your receiving the notice, whichever is later. Do that and your benefits continue at the current level until a decision is issued. This is called continued benefits, or aid pending.

One wrinkle worth knowing: the hearing request form has said 10 days from the mailing date while MassHealth policy guidance has said 10 days from receipt. Do not gamble on which reading applies to you. Count 10 days from the date printed on the notice and file inside that, and if you are already past it, file anyway and ask for continued benefits.

What is the real filing deadline?

60 days from when you received the written notice. You are presumed to have received it five days after it was mailed, so keep the envelope, because the postmark is your evidence if the date is ever argued about.

If no notice ever arrived and you only discovered the cut when the hours stopped, you have 120 days from the action itself. These limits are enforced strictly, so late is usually fatal.

How do I actually file it?

• By fax, which is fastest and gives you a transmission receipt. Complete and sign the fair hearing request form, state the reason briefly, attach the notice, and fax it to 617-887-8797.
• By phone, at 800-841-2900. You can complete the request over the phone. Ask for a reference number and write down who you spoke to.
• By mail, to the address on the form. Slowest, and the 10 day clock does not care that the post office was slow.
• With no notice in hand, send a short signed letter to the Board of Hearings describing what happened, with your name, address, phone number and member ID.

You can also ask for an interpreter or a disability accommodation on the request, and you should if you need one.

What should the appeal actually say?

Point at a line, not at the total. Before you write anything, ask your PCM agency for a copy of the completed evaluation worksheet. Your hours were built from minutes per episode times episodes per day times days per week, so somewhere in that grid is the entry you disagree with.

"My hours are not enough" is a feeling and it loses. "Toileting was recorded at two episodes a day, it is six, and here is a two week log" is a factual dispute and it wins. The same goes for a task recorded as minimum assist that is really maximum, a night need scored as nothing, or an activity left off entirely. The breakdown of how the hours are calculated will show you where to look.

What evidence helps?

• A dated log kept over at least two weeks, with times and what the help physically involved.
• A letter from the primary care provider describing function, not just diagnosis. A diagnosis does not produce hours. Dependence in specific tasks does.
• Physical and occupational therapy notes, which describe transfers and level of assist in the same vocabulary the tool uses.
• Documentation about equipment, including a lift you need, a lift that broke, or stairs you cannot manage.
• Anything showing a change since the last evaluation: a hospital stay, a fall, a new diagnosis, a progression.

What is the hearing like?

Usually a phone call. You get the date, time and place at least 10 days in advance. An impartial hearing officer, who is a lawyer, runs it, and somebody from MassHealth or the managed care plan appears on the other side. It is informal in tone but genuinely adversarial, and it is recorded.

The important procedural point in your favor: the hearing is de novo, meaning you are not limited to what was in front of the original decision maker. You can bring new evidence, submit documents in advance, and request subpoenas for witnesses. Settlement conversations before the hearing are common, and if you settle by withdrawing the request, do it in writing and make sure there is no gap in coverage.

How long until something happens?

Expect weeks, not days, for a hearing date. If you win, MassHealth should implement the decision within 30 days. If you lose, there are further appeal routes, but at that point you want somebody with legal expertise rather than a web page.

Who can help me with the appeal?

Start with your PCM agency, because the worksheet and the clinical record are there and a reassessment may solve it faster than a hearing. For representation, the Disability Law Center and your regional legal services office both handle MassHealth appeals and cost nothing, and if the member is over 60 the Councils on Aging and SHINE counselors can point you to local help. Ask early. These offices have limited capacity and a hearing date you cannot prepare for is worse than one you postponed.

What do we do about coverage in the meantime?

If you filed in time, nothing changes while you wait, which is the whole reason the 10 day window matters. If you missed it and the hours are already gone, the realistic options are to cover the gap privately, lean harder on family for a few weeks, or ask the Aging Services Access Point in your town what they can fill. Our home health aide care is $45 an hour from one to eight hours a day, with no minimum contract and no assessment fee, which exists for exactly this kind of gap rather than as a replacement for the hours you are owed.

Care Remedy is a personal care management agency serving eastern and central Massachusetts from offices in Woburn, Brockton and Springfield. If your hours were cut and you are not getting straight answers from your current PCM, you can transfer. Call 781-957-8076 or email pcm@careremedy.com.

This is general information about the appeal process and not legal advice. Deadlines and procedures are set by MassHealth and can change, so confirm them on your own notice or with the Board of Hearings.