Reactivate/Terminate an Existing Worker


If your worker has been inactive for less than 12 months, you can reactivate them by sending in (fax or mail) a signed letter advising us to do so. Please be sure to include your consumer number, sign and date your request. Keep in mind that if any of the worker’s information has changed (such as address, direct deposit information, tax withholdings, etc.) we will need that information updated on the appropriate forms. Direct Deposit information cannot be reactivated and a new form will need to be submitted with the activation letter, otherwise the worker will be reactivated with their payment issued as paper checks.

If it has been over a year since your worker has been active, they will need to fill out New Hire Paperwork, If you do not know or are unsure you can call us and we can confirm this information for you!

NOTE: If you prefer to send manually please fill out the following forms and drop off mail or fax to 800-359-2884. Please be sure to include your consumer number on each page. We advise for your records to write down the actual time it was faxed (not from a transmission report as those times may not be accurate) and call us 30 minutes after your documents are faxed to confirm receipt. Please note we cannot confirm receipt of any faxes on a Monday due to processing volume.


The forms below are for the MassHealth FI Program Only

Click Here for W4 and I-9 Forms

Click Here for M4 - MA State Withholding Form

Click Here for Direct Deposit Forms

Click Here for Debit Card Forms


Personal Care Attendant Signature Form (English)

Personal Care Attendant Signature Form (Spanish)


The following forms although optional are suggested for faster, more convenient processing of timesheets. Please click here for more information: Use E-Timesheets (For use in FI PCA Program Only). Please note that these timesheet forms are the same on this page and the "Use E-Timesheets" page.


Click Here for Electronic Timesheet Agreement Forms and Samples


For Other Programs

Consumer Directed Care (CDC)
Money Follows the Person Waiver Program (MFP)
Please contact your agency or representative for additional/specialized forms



For whatever reason, if your worker is no longer working for you, you will need to deactivate them on your account. In order to do this we need a signed and dated letter from you or your worker indicating they no longer work for you. Please be sure to sure to include their last day worked, reason for separation and your consumer number and drop off, mail or fax to 1.800.359.2884. You can also have this information updated by submitting a change form.