Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees
AI Summary
Effective January 1, 2026, Massachusetts Medicaid (MassHealth) enrollees in Senior Care Options (SCO) and One Care plans who lose Medicaid eligibility will enter a 60-day Medicare deeming period where only Medicare benefits are covered. Medicaid-covered services will not be reimbursed during this period, and providers must establish separate payment agreements with members for these services.
Action Required
Immediately: Billing team must verify member eligibility in UnitedHealthcare Provider Portal before providing services. If Medicaid shows inactive with end date, member is in deeming period and Medicaid services will not be reimbursed. Establish separate payment agreements with members for any Medicaid-covered services provided during 60-day deeming period. Update billing workflows to flag SCO and One Care members for eligibility verification.
Affected Billing Codes
Plan Types
Medicaid
States
MA
Specialties
geriatrics, family-medicine, internal-medicine, all-specialties