MassHealth MADS-MR Release Forms for Disability Applications

When a young adult with a disability applies for MassHealth coverage based on disability (rather than through automatic SSI-linked enrollment), the application requires the MassHealth Adult Disability Supplement — and that supplement requires multiple signed copies of the MADS-MR medical release form. This is the step where applications stall, because families either do not submit enough copies or do not understand who must sign them.

What the MADS-MR Form Is

MADS-MR stands for MassHealth Adult Disability Supplement — Medical Records Release. It is a HIPAA-compliant authorization form that gives the Disability Evaluation Services (DES) office permission to request medical records from the applicant's healthcare providers. DES reviews these records to make an independent clinical determination of whether the applicant meets MassHealth's disability standard.

The form itself is straightforward: the applicant's name, date of birth, Social Security number, the provider's name and address, and a signature authorizing the release. What trips families up is the volume — you need a separate, signed MADS-MR form for every medical provider whose records DES should review.

How Many Copies You Need

Each Adult Disability Supplement includes five MADS-MR copies. Complete one for every medical or mental health provider listed; obtain additional copies if needed. For a young adult transitioning from pediatric to adult care, the relevant providers typically include:

• The primary care physician (or pediatrician)
• The psychologist or neuropsychologist who conducted IQ and adaptive behavior testing
• Any psychiatrist prescribing medications
• The hospital or clinic where developmental evaluations were performed
• Therapists (speech-language, occupational, behavioral) who have current treatment records

Families who submit fewer forms than the number of providers listed risk a slower determination, because DES may need records from providers not listed on the authorization and will have to contact the family to request additional forms — adding weeks or months to the process.

Who Signs the Form

At age 18, the applicant is the only person who can legally authorize the release of their medical records under HIPAA. If the applicant has a court-appointed guardian with authority over medical decisions, the guardian signs. If the family has a supported decision-making agreement in place, the supporter can assist the applicant in understanding the form, but the applicant themselves must sign.

This is where families who have not yet addressed legal decision-making at 18 run into trouble. If the young adult cannot provide the required authorization and no guardian or other legally authorized representative is available, DES may be unable to obtain the listed records; ask MassHealth/DES how to document authority before submitting. This is one of the practical reasons why transition planners recommend resolving the legal framework (guardianship, supported decision-making, or health care proxy) before submitting the MassHealth application.

Assembling the Application Package

The complete MassHealth disability application for a transition-age young adult includes:

1. MassHealth application form (ACA-1 for new applicants or the renewal form if transitioning from child Medicaid)
2. MassHealth Adult Disability Supplement — the clinical questionnaire that asks about functional limitations, daily activities, and medical conditions
3. Signed MADS-MR forms — one per provider (the supplement includes five copies; obtain more if needed)
4. Supporting clinical documentation — copies of neuropsychological evaluations, IEP transition assessments, psychiatric reports, and any prior disability determination letters (from SSA or another state agency)

The package can be mailed to the MassHealth Disability Evaluation Services office in Worcester or faxed to DES at (774) 455-8156; current MassHealth instructions also accept electronic signatures on the MADS-MR forms.

Common Mistakes That Delay the Determination

Submitting blank provider fields. Each MADS-MR form must include the full name, address, and phone number of the specific provider. Forms with incomplete provider information are returned.

Using outdated provider addresses. Pediatric providers that the individual no longer sees may have closed or moved. Verify the mailing address for each provider before submitting.

Not including the Adult Disability Supplement. The MADS-MR forms alone are not sufficient — DES needs the Adult Disability Supplement questionnaire to understand the nature and severity of the applicant's disability. Submitting one without the other triggers a request for the missing document.

Missing an updated authorization request. Check the current form instructions and respond promptly if DES requests updated authorizations.

The Massachusetts Adult Benefits Guide includes a document inventory checklist that tracks every form, evaluation report, and authorization needed for the MassHealth disability application — helping families submit a complete package the first time rather than waiting for DES to send back requests for missing pieces.

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