Medicare AdvantageCoverageHigh impact
Massachusetts Medicaid: Eligibility changes for SCO, One Care enrollees
UnitedHealthcare·MA·State news
Effective date
Jan 1, 2026
We identified it
Mar 1, 2026
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.