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MassHealth Managed Care Notices Mailed Nov 13-Dec 22 2017

Date: 
11/15/2017
Author: 
MassHealth & MLRI

Starting on Nov 13, and continuing through Dec 22, 2017 MassHealth is notifying 1.2 million members enrolled in managed care of new options starting March 1, 2018 including new Accountable Care Organizations. This is the Delivery System Reform Innovation approved in the November 2016 amendment to the 1115 Waiver. Today these members are in one of six Managed Care Organizations (MCOs) or the Primary Care Clinician Plan (PCCP). Starting March 1, 2018, they will be in one of two MCOs, the PCCP, or one of 16 new Accountable Care Organizations (ACOs). To prepare for this massive change in plans, MassHealth identified each member’s primary care provider (PCP) and will prospectively enroll members whose PCP joined an ACO into that ACO on March 1. (PCPs who join an ACO are exclusive to that ACO. They cannot be PCPs in any other ACO, an MCO or the PCCP).

On Nov 24, MassHealth will begin sending notices to about 815,000 members whose PCP joined an ACO telling them they will be enrolled in that ACO on March 1, 2018 unless the member makes another choice. MassHealth started sending notices on Nov 13 to the other 300,000 members now in managed care.  About 200,000 of this group are in one of the two returning MCOs or the PCCP and their PCP did not join an ACO. They will be told they will remain with their current plan on March 1 unless they make another choice. About 100,000 people are in MCOs that will not continue after March 1 and have a PCP who did not join an ACO or have a PCP who joined an ACO that does not cover the member’s zip code. They will be told to select a new plan by March 1, 2018 or MassHealth will auto-assign them to one of the available options. It is particularly important that this group look into their options and select the best-suited plan for them in advance of March 1.

All 1.2 million members will be told that they can select from any available option for coverage starting March 1, 2018. All will be told they can freely change plans for 90 days after March 1, 2018, but will only be able to change plans for cause from June 1, 2018 to Feb. 28, 2019.

The link below is to a new website called MassHealthChoices.com. It  contains information on plan choices, explains ACOs, the importance of selecting a PCP and has links to provider directories and an online enrollment form.

Attached is

  • a powerpoint on these changes prepared by MassHealth for the October 2017 MassHealth Training Forum,  
  • a Table comparing the plans available in 2017 to those available in 2018 prepared by MLRI. 
  • November 2017 All-Provider Bulletin 272 on MassHealth Payment and Care Delivery Innovation that include a 5 page table showing for each of the 19 plans -- the name, tel & website and a reproduction of the member card
  • Enrollment Guide with more information on plan choices including hospitals in each plan network
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