Are you a provider from MA that accepts UHC plan types mentioned below and is having issues with reimbursement? It could be due to a recent MA Medicaid (MassHealth) change to the eligibility for DSNP plan members.
Plans affected: UHC Community Health plan ls of Massachusets-DSNP plans:
- Senior Care Options
- One Care
Due to a termination of MA Medicaid (MassHealth) coverage for the members on these 2 plans, UHC will update the coverage for the benefits.
What is happening: UHC
- MA Medicaid (MassHealth) eligibility for the members ended on 1/1/26
- UHC disenrolled these members at the end of the month (Jan 2026)
- Medicaid covered benefits are no longer reimbursed for any member past 1/1/26
- UHC will cover Medicare benefits during the (60-day deeming period).
- During the 60-day seeming period the members are responsible for any financial responsibility for provider visits, clinic visits, hospital visits, etc.
Some Medicaid/MassHealth benefits that are not going to be covered/reimbursed: not all inclusive
- Adult and group foster care
- Day habilitation
- Chore and homemaker services
- Home-delivered meals
- Laundry services
- Consumer-directed care
- Personal emergency response services
Benefit coverage for Senior Care Option members ONLY, during the 60-day deeming period:
Personal Care Attendent services:
Adult Day Care:
Non emergency transportation:
- SafeRide provides these services
- Is not a covered benefits during the 60-day deeming period
All other plans, including One Care- none of the services mentioned above are covered during the 60-day deeming period
What should your practice do?
- Check the member eligibility and benefits info on UHC provider portal.
- If you as a provider chooses to provide Medicaid non covered services during the 60 day deeming period- you will need to work out a direct agreement between your practice and the member.
Directing your members how to restore their Medicaid coverage:
- Members should have received an advance notice about their coverage termination
- Members need to contact MA Medicaid directly and go through a re-determination process
- Once the member is determined meet the Medicaid eligibility the new eligibility date will be given and it will NOT BE BACKDATED.
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