MA Health Care Learning Series

MassHealth Health Plan Updates: Relaunch of ACO Programs

MassHealth managed care eligible members include members younger than 65, with no TPL (including Medicare), living in the community, and in the following MassHealth coverage types: Standard, CarePlus, CommonHealth, or Family Assistance can select to join an Accountable Care Organization (ACO) plan, Managed Care Plan (MCO), or the Primary Care Clinician (PCC) plan. MassHealth originally launched the Accountable Care Organization (ACO) program in March 2018. Through a re-procurement, MassHealth selected 17 healthcare organizations to participate in the MassHealth ACO program. The new health plans will launch on April 1, 2023. MassHealth ACOs are integrated networks of physicians, hospitals, and other community-based healthcare providers that are accountable for the quality, cost, and member experience of care for 1.2 million MassHealth members.

In February, members were mailed notices providing updates about their enrollment in the MassHealth health plan. Member enrollment in ACOs will be based on their relationship with their current primary care provider to ensure continuity of care. Members generally follow their Primary Care Providers (PCP). If a member’s PCP assignment is not available in our systems, the member will move with their ACO partner.

Depending on whether a member is special assigned, or not being moved to a new plan, they will receive different messaging in 2023.

At the end of the webinar, you’ll be able to:

• Identify MassHealth’s health plan options available for selection starting April 1, 2023

• Describe the types of messages members may receive about their health plan enrollment

• Identify key dates, continuity of care period, and actions

• Explain how members can learn, find a MassHealth health plan or providers, and enroll in a plan

MassHealth for Seniors and Individuals Seeking Long-Term-Care Services (LTC)

MassHealth provides health care benefits for eligible children, families, seniors, and people with disabilities living in Massachusetts. MassHealth may offer benefits directly or help pay for all or part of a member’s health insurance premiums. As a MassHealth member, they may have access to doctor visits, dental visits, prescription drugs, behavioral health services, and other important health care services. The first step individuals need to take is to apply. 

The MassHealth for Seniors and Individuals Seeking Long-Term-Care Services (LTC) webinar series will review and step through how seniors and people needing long-term-care services apply, renew, and programs for seniors. The Application for Health Coverage for Seniors and People Needing Long-Term-Care Services, commonly referred to as the SACA-2, is for seniors and persons of any age needing long-term-care services.

The MassHealth for Seniors and Individuals Seeking Long-Term-Care Services (LTC) webinar is a three-part series that will guide you as you help individuals 65 years of age or older or any individual seeking long-term-care services apply for health care benefits. You will also learn about educating individuals on how they can maintain their health care coverage. 

In Part 1 (August 2022), you will be able to:

• Explain who can use the Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2) and the MassHealth Buy-In for people who are eligible for Medicare

• Describe eligibility requirements

• Demonstrate how to complete each section of the SACA-2 application and the MassHealth Buy-In for people who are eligible for Medicare

• Identify what documents are required and how to submit them
• Discuss best practices for handling SACA-2 applications

In Part 2 (November & December 2022), you will be able to:

• Describe the MassHealth coverage types for seniors and people of any age who need long-term-care services
• Describe the MassHealth health plans and programs for eligible seniors

The MassHealth for Seniors and Individuals Seeking Long-Term-Care Services (LTC): Renewal webinar is the third part of our 3-part series. This session will focus on renewals and will guide you as you help individuals 65 years of age or older or any individual seeking long-term-care services renew their health care benefits. 

In Part 3: Renewal (March 2023), you will be able to:

• Describe the senior renewal requirements

• Explain how to complete a MassHealth renewal for seniors
• Describe ways MassHealth seniors can submit their renewal

• Identify tips and best practices for helping seniors who already receive benefits and want to renew their coverage

Click on the link below to access the presentation material.

• MassHealth for Seniors and Individuals Seeking Long Term-Care Services (LTC) Part 1 - PowerPoint presentation

• MassHealth for Seniors and Individuals Seeking Long Term-Care Services (LTC) Part 2 - PowerPoint presentation

Understanding MassHealth Cost Sharing Policy Update Webinar: Phase 2 - June 2021

MassHealth is making changes to limit the amount of cost sharing members pay. During the webinar, you will learn how MassHealth will calculate copays, new terms members should be familiar with, view new copay notices, and the new premium hardship waivers.  

This learning opportunity is for those who support MassHealth members. Attendees of this webinar will:

• Learn about MassHealth’s copay and premium policy updates.
• Hear information about how and when it will roll out.
• Learn about member notices and member resources.

• Understanding MassHealth Cost Sharing Policy Update: Phase 2 - PowerPoint presentation