Staff Portal
Call Now

Who is Eligible?

ACO and MCOs refer individuals with complex LTSS needs to Community Partners. ACOs and MCOs will identify members with complex LTSS needs through a number of mechanisms including:

  • Care Needs Screening
  • Member self-referrals
  • Referrals from CPs, providers, or other individuals familiar with the member

The LTSS CP Focus population of individuals with complex LTSS needs are MassHealth Members with $300 plus spend on LTSS over 3 consecutive months. Examples of eligible participants will include those who receive the following services:

  • PCA Services
  • Home Health
  • Independent Nurse
  • Adult Foster Care
  • Group Adult Foster Care
  • Adult Day Health
  • Day Habilitation

Other criteria include:

  • Individuals with complex LTSS needs
  • Individuals with brain injury or cognitive impairments
  • Individuals with physical disabilities
  • Individuals with Intellectual Disabilities and Developmental Disabilities (I/DD), including Autism
  • Older adults (up to age 64) with LTSS needs
  • Children and youth (ages 3 - 21) with LTSS needs