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Get Ma Ard-1122 2022-2024

For you, or if you are an authorized representative applying on behalf of someone else, you MUST submit this form for the application to be processed. You do not need to fill out this form if you live in an institution and want copies of eligibility notices sent to you and to your spouse who still lives at home. We will do that automatically. Note: An authorized representative has the authority to act on an applicant's or member's behalf in all matters with MassHealth and the Health Connector,.

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