Year: 2025

Changes to MassHealth’s Accountable Care Organizations on January 1, 2026

As part of MassHealth’s annual Accountable Care Organization (ACO) program update process, there will be changes to ACO service areas, hospitals, providers, and health plans within the managed care program effective January 1, 2026. Please reference All Provider Bulletin 410 at https://www.mass.gov/lists/2025-masshealth-provider-bulletins for more details. For questions or concerns: LTTS providers, please contact the LTSS… Continue Reading Changes to MassHealth’s Accountable Care Organizations on January 1, 2026

Electronic Visit Verification (EVV) Match Informational Explanation of Benefits (EOBS)

MassHealth EVV soft edits are now live, and you may see new EVV messages on your Remittance Advice (RA). For claims for EVV services processed through MassHealth, you may begin to see codes on your RA indicating whether a matching EVV visit was found in the Sandata EVV Aggregator for the EVV service on the… Continue Reading Electronic Visit Verification (EVV) Match Informational Explanation of Benefits (EOBS)

Health Connector Preliminary Eligibility Notices are Mailing

Notices for Health Connector Redetermination are Being Mailed! Preliminary Eligibility notices for the Health Connector’s Open Enrollment 2026 are now being sent to members through mid-September. Some members may have already received their notices. These notices tell members about: their estimated 2026 Federal Poverty Level (FPL) their program eligibility based on information that is currently… Continue Reading Health Connector Preliminary Eligibility Notices are Mailing

Health Connector Federal Policy Updates: ConnectorCare Program Changes

Health Connector Federal Policy Updates The federal government recently passed a budget reconciliation bill on July 4, 2025. As a result, many Health Connector members will see increases in the cost of their health insurance or changes in their eligibility, access to coverage, or the amount of financial help they’re able to receive. For Plan… Continue Reading Health Connector Federal Policy Updates: ConnectorCare Program Changes

Enrolling Qualified Medicare Beneficiary (QMB) Members in Medicare

MassHealth requires members to enroll in health insurance they have access to that’s at no cost to them, including Medicare. This is because MassHealth is the payer of last resort and pays for health care and related services only when no other source of payment is available, except when required by federal law. Qualified Medicare… Continue Reading Enrolling Qualified Medicare Beneficiary (QMB) Members in Medicare

Employee Sponsored Health Insurance Verification Effort

Applicants and members who receive affordable employer-sponsored insurance (ESI) are not eligible for Advanced Premium Tax Credits (APTCs). If an applicant or member is not offered ESI or is offered an unaffordable plan, they may be eligible for APTCs if they meet other eligibility requirements. The Health Connector verifies access to ESI by sending notices… Continue Reading Employee Sponsored Health Insurance Verification Effort

Health Connector Walk-in Center Closures

All Health Connector walk-in center locations will be closed as of June 27th. These closures come as part of an effort to streamline services and expand access to other free and local options. The last day of operation for each location is listed below: Springfield (88 Industrial Ave.), closed on March 28 Worcester (146 Main St.),… Continue Reading Health Connector Walk-in Center Closures

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