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Six changes affecting MassHealth on Jan 1, 2020

Vicky Pulos

Six changes affecting MassHealth on Jan 1, 2020:

Primary Care Providers Joining New ACOs Jan 1

MassHealth notified 37,000 members whose primary care provider joined a new ACO that they would be assigned to that ACO on Jan. 1, 2020. The list of providers changing plans is here:

A change in ACO plan can disrupt access to specialists & other providers who were part of the old plan but not the new plan.  There are Continuity of Care protections for the first 90 days after the change to an ACO described here:

Continuity of care protections require the new plan to temporarily pay specialists who are not in their networks. The specialist must contact the plan to work out the logistics. Contact info for the plans and for their behavioral health vendors are here:

Members who are not happy with their new ACO can change plans during their plan selection period, but will have to find a new primary care provider. More info on plan selection is here:

Medicare Savings Program Expansion eff. Jan 1

More Medicare beneficiaries will now qualify for help paying for Medicare Part B premiums and  other costs thanks to higher income and asset limits for the Medicare Savings Program/Buy-In programs. An outreach toolkit is here:

Social Security and Medicare Cost of Living Adjustments for 2020

The Social Security cost of living adjustments in Title II and  SSI benefit rates took effect Jan 1 along with  adjustments to Medicare cost-sharing and other amounts. Medicare Part B premiums for most people went up to $144.60 per month. The 2020 amounts are summarized in this SSA publication:

 In Massachusetts SSI  benefit amounts include both the federal amount and a state supplement. The 2020 SSI payment standards are posted on the MassHealth website here:


MassHealth Cost of Living Adjustments for 2020

The Federal Poverty Level COLA usually comes out at the end of January and MassHealth updates its income guidelines based on the FPL on March 1.  However, some of the financial standards used by MassHealth are based on other adjustments and updated January 1.  These are posted here

Jan 1, 2020 adjustments include the Buy-In asset limits and the upper income limit for PACE and HCBS waivers which is set at 300% of the SSI Federal Benefit Rate. In 2020 the 300% FBR rate will be $2349 per mo for an individual (up from $2313 in 2019).

Also adjusted Jan 1, 2020 are several standards used in determining eligibility for nursing home eligibility including the home equity limit, the community spouse resource maximum, and the maximum monthly needs allowance for a community spouse.

Personal Care Attendant (PCA) Changes Jan 1

MassHealth entered into new contracts with Personal Care Management (PCM) agencies effective Jan 1, 2020.  PCMs are responsible for many aspects of the PCA program including making an assessment and requesting authorization for hours of service. Five agencies that provided PCM services in 2019 and prior years were not chosen in 2020 and a 6th did not seek renewal. Approximately 2300 MassHealth members who had been using one of the six non-renewing PCMs were reassigned to new PCMs, but are free to choose any available PCM. In addition One Care and SCO plans were given the option to drop one or more of the non-renewing PCMs from their PCM networks effective Jan 1.

The non-renewing PCM agencies are: BayPath Elder Services, Family Services Associates of Greater Fall River, Montachusett Home Care Corp (MHCC), Old Colony Elder Services and Toward Independent Living and Learning (TILL), and PRIDE.

One thing to watch out for is whether a new PCM may recommend fewer hours than the former PCM when there has been no improvement in the member’s condition or circumstances. A reduction in hours like this will probably require legal advocacy just to get a hearing.

Amended PCA regulations at 130 CMR 422 also took effect on Jan 1. See Transmittal Letter 23 (January 2020) which summarizes various updates & clarifications.

Automatic Voter Registration with Opt Out eff Jan 1

Beginning Jan 1, 2020 a 2018 state law takes effect providing that certain Massachusetts residents who do not opt out will be automatically registered to vote when they renew their driver’s license or apply for coverage through MassHealth or the Health Connector.

MassHealth and the Connector have made changes to the online application to allow a head of household who meets the age, residence and US citizenship criteria for voting and does not opt out to have this information forwarded to the Secretary of State in order to be registered to vote.  MassHealth and the Connector have supplied a training for assisters & navigators about this new process. More information is here:


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