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Below is an addendum to your rights and responsibilities as a Low-income patient (114.6 CMR 13.08(2)) when applying for assistance in paying for medical and/or dental services.


Patient Rights | Patient Responsibility

A Low-income patient has the right to:

  • good, quality healthcare from the BNHC regardless of age, race, sex, national origin, citizenship, religion, culture, physical handicap/disability, personal values or beliefs systems.
  • apply for MassHealth or other low income programs. In order to be determined a Low-income patient, you must complete a MBR and submit all required documentation. Our Intake and Pre-registration Offices are available during posted office hours to assist you.
  • a payment plan, as described in 114.6 CMR 13.08(1)(f), if the patient is determined to be a Low-income patient pursuant to 114.6 CMR 13.00 or a patient that qualifies for medical hardship (114.6 CMR 13.05).
  • a written healthcare benefit notice of your eligibility for assistance should be sent to you within 30 days from the Division of Medical Assistance. IMPORTANT: The benefit notice has two parts. The 1st part explains if you are eligible for MassHealth benefits; the 2nd part states if you qualify for HSN. If you have not received a written notice or need more information, please return to the BNHC for assistance.
  • file a written grievance for review of the MA-21 determination of denial of HSN or medical hardship benefits with all supporting documentation to: Division of Health Care Finance and Policy, Health Safety Net Office, Two Boylston St, Boston, MA 02116. For all grievances, the Office may request additional information from the grievant, other state agencies, and/or the Brockton Neighborhood Health Center. Additional information requested by the Office must be submitted within 30 days.



Patient Rights | Patient Responsibility

A Low-income patient that receives eligible services must:

  • provide all required documentation in order to qualify and retain low-income medical/dental benefits.
  • inform MassHealth and the BNHC of any changes in family income, residency or insurance status. For instance, if any mail that is sent to you by the Office of Medicaid is returned, you will be deemed a non-resident and your medical/dental benefits will be terminated.
  • keep track and supply documentation of more than one family member deductible and/or deductibles from more than one provider of services for Partial Health Safety Net (formerly Free Care) benefits. The family member MUST be a Low-income patient to qualify for family deductible. Once your deductible is met, you will be deemed eligible for Full Health Safety Net (HSN) benefits.
  • inform the Division or MassHealth within 10 days that he/she was involved in an accident, or suffered from an illness or injury, or other loss that has or may result in a lawsuit or other 3rd party payment of a claim billed to HSNO. The patient must assist or assign rights to recover previous payments to the Division and/or repay net amounts he/she received from other 3rd party sources to HSNO for services paid by HSNO.


Patient Rights | Patient Responsibility

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