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