Massachusetts Medicaid: What you need to know about recent dual-eligibility changes

Affects Senior Care Options and One Care members

Effective Jan. 1, 2026, UnitedHealthcare Community Plan of Massachusetts implemented important dual-eligibility changes due to the loss of MassHealth Medicaid eligibility for Senior Care Options (SCO) and One Care enrollees. 

What happens when MassHealth Medicaid eligibility ends

• Members will be disenrolled at the end of the month in which their MassHealth Medicaid eligibility ends
• We will continue to cover Medicare benefits only, including supplemental coverage, during the plan’s 60-day Medicare deeming period 
  • Members will be responsible for any applicable patient liability for primary care visits, specialist visits, hospital care, etc.
  • During this period, services not covered under Medicare will not be reimbursed
  • See the 2026 UnitedHealthcare Care Provider Manual for more details
• Medicaid-covered services will not be reimbursed after the date Medicaid eligibility ends, even during the deeming period

Verifying eligibility in the deeming period

If a member is in the deeming period (loss of MassHealth eligibility), providers must determine if the member is still eligible for services by confirming their eligibility for the plan. This information can be found in the UnitedHealthcare Provider Portal. If Medicaid shows inactive with an end date, the member may be in the deeming period. Medicaid-only services will not be reimbursed.

Restoring Medicaid eligibility

To restore Medicaid eligibility, members will need to complete the redetermination process with the state. Once approved, Medicaid benefits will begin on the updated eligibility date and will not be retroactive to the date coverage previously ended.

Medicaid/MassHealth-covered services may not be reimbursed after a member loses Medicaid. These services include but are not limited to:

• Adult and group foster care
• Day habilitation
• Chore and homemaker services
• Home-delivered meals
• Laundry services
• Consumer-directed care
• Personal emergency response services

SCO enrollees in plan benefit package H2226 003 only

Personal care attendant and adult day health benefits are coordinated between Medicare and Medicaid. During the 60-day deeming period, members within plan benefit package H2226-003 may be eligible to continue receiving the following limited services, including wraparound services.

All other enrollees (non‑H2226‑003, including all One Care enrollees)

These services are not covered for other members during a Medicare deeming period. A list of eligible members will be provided to fiscal intermediary (FI) and personal care management (PCM) agencies.

Provider responsibilities

• If you choose to continue providing Medicaid-covered services during the 60-day Medicare deeming period, you must establish a separate payment agreement with the member. UnitedHealthcare Community Plan of Massachusetts will not provide reimbursement for these services.
• Members will receive notice in advance of the potential loss of MassHealth, including steps to be taken by the member to remain with MassHealth coverage
• This serves as a reminder that non‑Medicare‑covered services will not be reimbursed during the deeming period

Questions? We’re here to help.

We appreciate your continued partnership and commitment to serving our members. If you have any questions, please email HCBS Provider Services at mahp_hcbspra@uhc.com.