MedicaidReimbursementMedium impact
Managed Care Entity Bulletin 147: Guidance for Payment to Community Partners During CP Program Transition
MassHealth·MA·Claims & Billing
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
MassHealth is removing the Capitation Payment Deduction policy and replacing it with a one-time Transition of Care Coordination Payment that ACOs and MCO must make to Community Partners for care coordination support during January-June 2026. This payment must be incorporated into the June 2026 Expected Payment File and affects how Community Partner payments are calculated and distributed.
Action Required
By June 2026: Billing teams working with MassHealth ACOs, Primary Care ACOs, and MCO must incorporate the one-time Transition of Care Coordination Payment into the June 2026 Expected Payment File as specified by EOHHS. Monitor for forthcoming contract amendments and updated CP File Specifications. Ensure Community Partner payments meet the 98% threshold requirement to avoid additional enrollment-based proportion payments.