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What You Need To Know About MassHealth Accountable Care Organization Changes

What You Need To Know About MassHealth Accountable Care Organization Changes

February 28, 2018

Starting tomorrow, MassHealth is enrolling most members into new health plan options, including Accountable Care Organizations. The change will impact up to 1.2 million MassHealth members.

What are MassHealth Accountable Care Organizations (ACOs)?

ACOs are provider-led organizations that coordinate care and are accountable for the quality and total cost of care of its members. Primary Care Providers (PCPs) work together with members and their team of network providers to coordinate care and connect members with available services and supports. MassHealth ACOs are a new kind of managed care option.

Who is eligible to enroll in an ACO?

People who are required to enroll in some kind of MassHealth managed care plan are eligible to enroll in an ACO. This only affects people who have MassHealth as their only health insurance coverage.

Who is not eligible to enroll in an ACO?

  • People who are enrolled in MassHealth and other health insurance coverage (for example Medicare or employer-sponsored health insurance).
  • People who are eligible for or enrolled in One Care, Senior Care Options (SCO), or PACE.
  • Seniors who are eligible for MassHealth based on their age.
  • People who are only eligible for or enrolled in MassHealth Limited.

Will an ACO be my only option for coverage through MassHealth?

In most areas of Massachusetts, MassHealth members required to enroll in managed care will have the following health plan options:

  • One or more ACO
  • Two Managed Care Organizations (MCOs) – Tufts Health Together and BMC HealthNet
  • Primary Care Clinician (PCC) Plan with the Massachusetts Behavioral Health Partnership

When do new plan options go into effect?

New MassHealth plan options, including ACOs, go into effect March 1, 2018. If you received a green-stripe letter, these new options apply to you. You may have already been assigned to a new ACO.

Can I keep all my current doctors?

MassHealth assigned members to plans that their primary care provider (PCP) participates in. You should check your doctors and/or your health plan to make sure your other providers, including specialists, are included in the new plan’s network. If they are not, you can work with you provider and plan to see if they can join the network, or you may consider switching plans.

What happens to prior authorizations or upcoming medical care?

Even if your current providers are not in your new plan or your new plan has not authorized your services, you will be able to keep scheduled appointments with your current providers and use previously authorized services through at least May 31st. You should work with you plan and providers to figure out your options after March 31st.

Will I be able to switch my ACO or health plan?

MassHealth members have until June 30, 2018 to switch plans. After that, MassHealth members can only switch plans for certain reasons, until March 1, 2019. People who become eligible for MassHealth after March 1, 2018 will have 90 days from the start of their MassHealth coverage to switch plans.

Where can I get more information about my enrollment options?

-Suzanne Curry