Some Cape Cod MassHealth patients have new cards

Beginning April 1, MassHealth recipients have started to receive notification to renew their eligibility determination (after a three-year pause during the pandemic). But, MassHealth recipients who receive their medical care through a Cape Cod Healthcare ACO physician or facility will also notice a change in their health insurance cards as of April 1.

The new card, which should have arrived in patients’ mail, now says “WellSense Community Alliance” and has the Cape Cod Healthcare ACO logo on it. Nothing will change for patients and, beyond confirming their eligibility with MassHealth when their anniversary date arrives during the year, they will not need to do anything to continue receiving care through Cape Cod Healthcare, said Gemma Jones, director of PHO Clinical Integration and Operations for the Cape Cod Healthcare ACO.

“For Medicaid, or MassHealth patients, their insurance cards will change, but otherwise the coverage is the same,” she said. “They will automatically be transitioned and then, when their eligibility expires after April 1, they will be notified through the MassHealth redetermination process.”

The fact that the new cards are arriving at the same time the MassHealth redetermination pandemic pause ended is just coincidental, Jones said.

What is the ACO?

The Cape Cod Healthcare ACO, or accountable care organization, is a partnership between CCHC and its most closely affiliated physicians in order to provide well-coordinated, high-quality care for a select group of patients. The ACOs in Massachusetts focus on managing population health – they ensure the patient gets the right care at the right time and cover a comprehensive care delivery from preventive care to chronic disease management and lifestyle changes.

Doctors figure prominently in the equation, working as part of a team to keep the community healthy in a high-quality, cost-effective way. Primary care providers are the “gatekeepers” to ensure their patients are receiving the care they need. The care may involve other provider specialists and Cape Cod Healthcare ACO’s Helping Hands program to be part of the care team. Helping Hands is comprised of registered nurses and licensed clinical social workers, a clinical pharmacist, a registered dietician and two navigators to help MassHealth/WellSense Community Alliance patients navigate through their health, wellness and health-related social needs. A navigator is embedded in both the Cape Cod Hospital Emergency Department and the Falmouth Hospital Emergency Department, Jones said.

The Cape Cod Healthcare ACO initially partnered with Steward Health as the overall manager of the plan in 2019, which was a five-year agreement that ended on March 31, 2023. CCHC ACO is now partnered with WellSense Community Alliance in delivering the care through this next Waiver Extension.

CMMS Waiver

MassHealth was awarded a “Section 1115 Demonstration Extension (or Waiver)” by the federal Centers for Medicare and Medicaid Services (CMMS) on Sept. 28, 2022. The waiver “has been a critical tool in enabling Massachusetts to achieve and maintain near-universal coverage, sustain the Commonwealth’s safety net, expand critical behavioral health services, and implement reforms in the way that care is delivered,” according to a MassHealth Fact Sheet on the waiver.

The $67 billion waiver is effective through Dec. 31, 2027.

The MassHealth program has set five goals for its new Section 1115 Waiver period, according to the fact sheet. They are to:

• Continue with and refine the ACO model.
• Reform and invest in primary care, pediatric care and behavioral health to expand access and move the delivery system away from fee-for-service healthcare.
• Advance health equity, addressing health-related social needs.
• Sustainably support the Commonwealth’s safety net, including increased funding for providers, with a continued linkage to accountable care.
• Maintain near-universal coverage, including updates to eligibility policies to support coverage and equity.