MedicaidAdministrativeMedium impact
MassHealth managed care enrollment update
Harvard Pilgrim Health Care·MA·Provider Newsletter
Effective date
Aug 1, 2026
We identified it
Sep 13, 2026
Summary
MassHealth is transitioning some members from managed care health plans to the MassHealth fee-for-service (FFS) program effective August 1, 2026 and December 1, 2026. Affected members remain eligible for MassHealth but will now be covered under FFS instead of a managed care plan. Billing teams must verify member eligibility in the MassHealth Eligibility Verification System and ensure the practice is enrolled as a fully participating MassHealth provider to bill FFS members.
Action Required
By July 31, 2026: Billing team must verify the practice's MassHealth provider enrollment status. If not currently a fully participating MassHealth provider, complete enrollment application via the MassHealth Provider Self-Service site (https://www.mass.gov/service-details/masshealth-provider-regulations) to enable billing of MassHealth fee-for-service members. Starting August 1, 2026, front desk and billing staff must use the MassHealth Eligibility Verification System for all member eligibility checks to identify whether patients are covered under managed care or fee-for-service. Update internal procedures to route fee-for-service claims separately from managed care claims. Reference APB 417 for detailed billing guidance. Failure to verify eligibility and route claims correctly may result in claim denials.