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Child isability Supplement - Mass.Gov

MassHealth Child Disability Supplement Commonwealth of Massachusetts | Executive Office of Health and Human Services Instructions for Completing the Supplement You have indicated on your MassHealth application that your Child has a disability. Disability standards require that the disability has lasted or is expected to last at least 12 months. UMass Disability Evaluation Services (DES) will review your Child 's disability application for MassHealth. It is very important that you complete this Disability Supplement . For your Child to get MassHealth based on his or her disability, you need to tell us about your Child 's medical and mental health providers. These providers may include doctors, psychologists, therapists, social workers, physical therapists, chiropractors, hospitals, health centers, and clinics from whom your Child has gotten or is getting treatment; and your Child 's daily activities and his or her educational background.

4 Please go to the next page. PART 3 Your child’s activities of daily living Movement and general hygiene: Please indicate your child’s function level by putting a checkmark in one of the columns for

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