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: