SCO Eligibility Changes FAQ: Post-Transition

The eligibility requirements for Senior Care Options (SCO) plans have changed. This page explains what’s changing and outlines resources available to providers and members.

Contact Information for Urgent Continuity of Care Issues

Members should call MassHealth Customer Service at [phone], TDD/TTY: 711 with any Continuity of Care questions or concerns.

Providers should use the following table.

Criteria	Contact Information for Providers
LTSS Prior Authorization (PA) Submission Issue	Call LTSS Provider Center at [phone] or email [e-mail]
LTSS Service Disruption	Call LTSS Provider Center at [phone] or email [e-mail]
Medical PA Submission Issue	Email the PA unit at [e-mail]
Medical Service Disruption	Email the PA unit at [e-mail]
Pharmacy PA Issue	The member should ask their provider to call the Drug Utilization Review unit at [phone]
Pharmacy Service Disruption	The member should ask their provider to call the Drug Utilization Review unit at [phone]
Dental PA Issue	The member should ask their provider to call the Dental Support line at [phone]
Dental Service Disruption	Call MassHealth Provider Customer Service at [phone] or the Dental Support Line at [phone]
Behavioral Health Services Disruption	Call MassHealth Provider Customer Service at [phone], TDD/TTY: 711 Members can call or text the BH Help Line at [phone]
Personal Care Attendant Service Disruption	Call LTSS Provider Service Center at [phone] or email [e-mail]
Durable MedicalEquipment (DME) Service Disruption	Call LTSS Provider Service Center at [phone] or email [e-mail]

Background

Why did some SCO members’ insurance change?

The State law addressing SCO eligibility changed. Starting in January 2026, members cannot be in a SCO plan if they are not also enrolled in Medicare Parts A and B.

SCO members without both Medicare Parts A and B were moved to MassHealth Fee-For-Service (FFS) on January 1,2026. These members still have MassHealth Standard coverage.

For more information, please visit 2026 SCO Eligibility Changes.

Enrollments

How can I tell if a member was transitioned from a SCO plan to MassHealth FFS due to the law change?

The member must call the MassHealth Customer Service Center at [phone]. The Customer Service Center can identify if they’ve been enrolled in MassHealth FFS.

Can members re-enroll in SCO after obtaining Medicare Part A and B?

After obtaining Medicare Parts A and B, members can contact MassHealth at [phone] or SCO plans directly to evaluate their options.

MassHealth Provider Network

Can a provider who only serves SCO members continue serving a member who was transitioned to MassHealth FFS?

Providers who want to serve members in FFS and be paid for their claims must enroll in the MassHealth FFS network if they aren’t already.

• Request an application to enroll as a FFS provider.
• Visit Provider Self-Service to check enrollment status in MassHealth.

Please note, providers who only participate in a managed care health plan will not be able to verify their information on the self-service platform.

Dental providers can enroll in MassHealth FFS by clicking “Join Our Network.”

ID Cards/ID numbers

How can members get a MassHealth FFS ID card?

If a member does not have a card, they can still get services from a provider with a MassHealth ID number and a photo ID. MassHealth Customer Service can provide a new ID card. Members should call [phone], TDD/TTY: 711 for assistance.

What if a member does no know their MassHealth ID number? 

 Providers/agencies can check the Eligibility Verification System (EVS). EVS providers important benefit information about MassHealth members. Eligibility verifications through the POSC can be performed via Direct Data Entry (DDE) for a single member verification or via Batch for checking multiple member verifications at the same time. 

Prior Authorizations (PAs)

When do PAs for members who transitioned from SCO to FFS expire?

When possible, MassHealth transferred PAs for services and medications. These PAs will expire on March 31, 2026. LTSS PAs for personal care attendant services will expire on June 30, 2026. 

When possible, MassHealth transferred PAs for services and medications. There PAs will expire on March 31, 2026. LTSS PAs for personal care attendant services will expire on June 30, 2026. Members should contact their providers to get a new PA in place before the PAs expire on March 31, 2026. 

If providers have any issues with PAs, they should refer to the contact numbers listed in the table above, under “Contact Information for Urgent Continuity of Care Issues.”

How do members know which PAs will expire?

MassHealth mailed notices to members and their providers about which PAs were transferred to the member’s new coverage. These are the PAs that will need to be extended or reviewed by the member’s provider.

Pharmacy/Prescriptions

What should members who transitioned from SCO to FFS know about getting their medications?

After January 1, 2026, these members won’t be able to get medications from a pharmacy that isn’t enrolled in MassHealth FFS. If their pharmacy isn’t enrolled with MassHealth FFS, they’ll need to find a new pharmacy. Many major pharmacies throughout Massachusetts, including CVS and Walgreens, are enrolled with MassHealth FFS.

To confirm that a pharmacy is enrolled with MassHealth FFS, please contact the MassHealth Customer Service Center at [phone], TDD/TTY: 711. You can also visit our website and select “pharmacy” under “Facility of Hospital” to find a local MassHealth pharmacy.

What should members know about mail-delivered medications?

Members may be able to get their medications by mail if their current pharmacy is enrolled with MassHealth FFS. Please follow the steps above if you’re not sure that a member’s pharmacy is enrolled with MassHealth FFS.

After January 1, 2026, members won’t be able to get mail order or home delivery from a pharmacy that’s not enrolled in MassHealth FFS.

What should members know about auto-refills?

Current regulations don’t allow pharmacies to automatically refill prescriptions. After January 1, 2026, member medications won’t be automatically refilled. Members need to request any refills directly from their pharmacy.

Will members have to pay for prescriptions?

MassHealth members have $0 copay for all prescription drugs and covered non-drug products through the pharmacy benefit. Personal Emergency Response System (PERS)

If a member must return a PERS device because the provider is not a MassHealth FFS provider, how can the member obtain a new device?

Members who meet eligibility requirements for PERS can get a new device from a provider that MassHealth will pay directly. 

The below table includes PERS providers in the MassHealth FFS network.

Provider Name	Phone numbers
ADT LLC	877-465-1787
Alert Sentry GroupLLC	877-253-7899
Be Safer At Home, INC	781-205-4996
Compass Alert Systems, LLC	413-583-3340
Lifeline Systems Company	800-368-2925
Link to Life	855-745-2249
Medscope America LLC	800-645-2060
My Guardian AngelPRS, LLC	413-624-0200
New England Emergency Response System, INC	800-888-0338
QMedic	877-241-2244
Staar Alert	800-338-7114

Transportation

How do members get transportation to Adult Day Health, Medical Appointments, or Social Activities?

Adult Day Health: Adult Day Health programs will arrange for and provide transportation to and from the Adult Day Health Center instead of a SCO care coordinator. Members should tell their Adult Day Health program that their insurance has changed to MassHealth FFS and they need their program to arrange for and provide transportation to and from the Adult Day Health Center.

Medical Appointments: Members will need to schedule transportation directly with a company called a ‘transportation broker’ instead of a SCO care coordinator. Members should tell their doctor that their insurance has changed to MassHealth FFS. Their doctor will need to submit a request for transportation via the Web Portal, called a “PT1 request.”

Social Activities: MassHealth FFS will pay for transportation to medical appointments but does not offer transportation to social activities.

Vision

How do members get eyeglasses, contact lenses, and eye exams?

Members can continue to receive eyeglasses, contact lenses, and eye exams through MassHealth FFS. Members will need to order eyeglasses from an authorized provider through MassCor, which is the Massachusetts Correctional Industries.

Dental

MassHealth is waiving all dental PAs for transitioning members until March 31, 2026.

Does MassHealth FFS cover dental implants?

MassHealth FFS does not cover dental implants. MassHealth FFS offers alternative dental benefits such as dentures. Your dentist can help advise on an appropriate procedure for you that is covered by the MassHealth FFS dental benefit.

Home Care Services and Meals

For members transitioning to FFS who currently receive SCO-covered home care and/or meals, what will happen to those services in January? 

The SCO will no longer pay for those services after 12/31/2025.

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Date published:	January 16, 2026