MedicaidAdministrativeLow impact
Acute Inpatient Hospital Bulletin 199: Updated Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
MassHealth·MA·Medical Policy
Effective date
Mar 1, 2025
We identified it
Jun 18, 2026
Summary
MassHealth has updated the Application for Health and Dental Coverage and Help Paying Costs (ACA-3) form with revised language for SNAP processing, information sharing requirements, and estate recovery notifications. The March 2025 version is now available and should be used for applicable patient applications.
Action Required
Immediately: Front desk staff should download and begin using the updated ACA-3 application form from mass.gov/lists/masshealth-member-applications for patients under 65 who don't need long-term care services and parents/relatives of children under 19. Continue to use SACA-2 form for patients 65+ or those needing long-term care services. Previous versions will still be accepted during transition period.