MedicaidCoverageHigh impact
Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees
UnitedHealthcare·MA · Geriatrics, Family Medicine, Internal Medicine·State news
Effective date
Jan 1, 2026
We identified it
Jun 13, 2026
Summary
Effective January 1, 2026, Massachusetts Medicaid members in Senior Care Options (SCO) and One Care plans who lose MassHealth eligibility will have Medicaid-covered services discontinued, with only Medicare benefits continuing during a 60-day deeming period. Providers must verify eligibility through the UnitedHealthcare Provider Portal and establish separate payment agreements with members if continuing Medicaid-only services during the deeming period.
Action Required
Immediately: Billing team must verify MassHealth eligibility through UnitedHealthcare Provider Portal for all SCO and One Care members before providing services. If Medicaid shows inactive with an end date, member is in deeming period and Medicaid-covered services will not be reimbursed. Establish separate payment agreements with members if continuing adult foster care, day habilitation, homemaker services, meal delivery, or other Medicaid-only services during 60-day deeming period. Update billing system to flag these members and prevent automatic Medicaid billing.