Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees
AI Summary
Effective January 1, 2026, Massachusetts SCO and One Care members who lose MassHealth Medicaid eligibility will have only Medicare benefits covered during a 60-day deeming period. Providers must verify eligibility through the UnitedHealthcare portal and will not be reimbursed for Medicaid-only services during this period.
Action Required
Immediately: Billing team must verify member eligibility through UnitedHealthcare Provider Portal before providing services to SCO/One Care members. Check if Medicaid shows inactive with end date indicating deeming period. Stop billing Medicaid-only services (adult foster care, day habilitation, chore services, home-delivered meals, etc.) for members in deeming period. Establish separate payment agreements with members if continuing non-Medicare covered services. Update billing workflows to distinguish between Medicare-covered and Medicaid-only services.
Affected Billing Codes
Plan Types
Medicare Advantage, Medicaid
States
MA
Specialties
all-specialties