Massachusetts Medicaid Announces Changes to Dual-Eligibility Rules

UnitedHealthcare Community Plan of Massachusetts has updated how dual-eligible coverage works when a Senior Care Options (SCO) or One Care member loses MassHealth Medicaid eligibility.

When a member’s MassHealth Medicaid eligibility ends

• The member is disenrolled at the end of the month in which their MassHealth eligibility ends.
• After that, UnitedHealthcare will continue to cover Medicare benefits only (including any plan supplemental coverage) during the plan’s 60-day Medicare deeming period.
• During the deeming period, the member may owe patient liability/cost sharing, such as for primary care, specialist visits, hospital services, and other Medicare-covered care.
• During this period, services not covered by Medicare won’t be paid.
• Once Medicaid ends, Medicaid-only services won’t be reimbursed, even if the member is still in the deeming period.
• See the 2026 UnitedHealthcare Care Provider Manual for complete guidance.

Checking eligibility during the deeming period

If a member has lost MassHealth, check their current plan coverage before providing services. Verify eligibility in the UnitedHealthcare Provider Portal.

Tip: If Medicaid shows inactive with an end date, the member may be in the deeming period. In that case, Medicaid-only services won’t be paid.

Getting Medicaid (MassHealth) back

To get Medicaid back, the member must complete the state redetermination. If approved, coverage starts again on the new effective date set by the state; it won’t be backdated to when it ended.

Medicaid-only services that may not be reimbursed after Medicaid ends

This includes (but is 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

Note for SCO members in plan benefit package H2226-003 only

For members in H2226-003, personal care attendant and adult day health benefits are coordinated between Medicare and Medicaid. During the 60-day deeming period, these members may be able to continue receiving limited services, including certain wraparound services (as allowed under plan rules).

Personal care attendant

Medicare benefit will cover 13 hours (52 units) per month.

Adult day health

Medicare benefits will cover the first 19 days per month. 

Non-emergency medical transportation (NEMT)

SafeRide is covered as a Medicare benefit under the SCO plan benefit package H2226-003 for trips up to 50 miles. This coverage does not apply during the deeming period for SCO PBP001 or for either One Care plan.

All Other Members (Not H2226-003, including all One Care)

During the 60-day Medicare deeming period, Medicaid-only services are not covered or paid for.

• If you still provide these services, you must make a separate payment agreement with the member.
• UnitedHealthcare will not reimburse Medicaid-only services during this time.
• Members will get advance notice if their MassHealth may end and what they need to do next.

Reminder: Services that are not covered by Medicare will not be reimbursed during the deeming period.