The 2019 Miss Massachusetts USA and Teen USA pageant concluded with Kelly O'Grady winning the title of Miss Massachusetts USA 2019 and Annie Lu winning the title of Miss Massachusetts Teen USA 2019. They also won the opportunity to represent Massachusetts at the 2019 Miss USA and Teen USA pageant.
The Top 5 finalists at the 2019 Miss Massachusetts USA pageant were:
First Runner-Up – Ashley Baptista
Second Runner-Up – Chelsea Demby
Third Runner-Up – Sabrina Victor
Fourth Runner-Up – Isabelle Varga
The Top 16 placements at the 2019 Miss Massachusetts USA pageant were:
Fatima Armaghan
Jaclyn Delmonico
Nicole Eacuello
Shumika Jean-Baptiste
Ashley Maiolatesi
Meghan McInnis
Rachel Miller
Nina Murray
Adriana Taylor
Shelby Thiem
Alexandria McBride
The Top 5 finalists at the 2019 Miss Massachusetts Teen USA pageant were:
First Runner-Up – Elizabeth Rives
Second Runner-Up – Noor Mohamed
Third Runner-Up – Karina Calhoun
Fourth Runner-Up – Isabella Riethmueller
The Top 15 placements at the 2019 Miss Massachusetts Teen USA pageant were:
Shirin Bakre
Megan Eugenio
Kiersten Khoury
Olivia Lindberg
Katisa Mosquea
Taylor Mulready
Livia Petrillo
Hevyn Pray
Francheska Rosado
Juneichka Rosario