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* 1. Name

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* 2. Where do you live?

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* 3. Email

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* 4. Phone

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* 5. Age of family member using MassHealth

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* 6. Primary Diagnosis

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* 7. Other Diagnosis

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* 8. MassHealth services:
Did you have a problem with keeping your primary care physician or specialist?

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* 9. Long Term Support Services: Please check if you had problems accessing these services.  Please use the comment box to explain

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* 10. Have you had a Long Term support Service assessment?  If yes please comment below

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* 11. Please let us know if you had problems with accessing the following.  Check all that apply and explain in the comment box

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* 12. Have you had any issues with prior authorization for services, durable medical equipment, or prescriptions?  If yes please explain

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* 13. Was the problem resolved

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* 14. Please share who you engaged with to resolve your issue.  Check all that apply

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* 15. If you receive case management services through MassHealth is it meeting your needs?

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* 16. When contacting MassHealth what was the length of time you were placed on hold?

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* 17. Any other problems with MassHealth services that you would like to share?

Thank you for completing this survey!

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