MassHealth Managed Care

  • Description
  • Funding History
  • Proposals

MassHealth Managed Care pays for health insurance coverage provided to children and adults through several types of managed care health plans: Managed Care Organizations (MCOs), Primary Care Clinician Plans (PCCs), and Accountable Care Organizations beginning in March 2018 (ACOs). Most of the close to 640,000 children enrolled in MassHealth receive coverage through one of these managed health care plans.

Managed Care Organization (MCOs) are health plans that are run by insurance companies. Each MCO has its own network of providers such as doctors, specialists, and hospitals. A MassHealth member in an MCO must choose a primary care provider from within that network, and use the network's specialists and hospitals. A specific set of community partners provide behavioral health care and long-term care services.

The Primary Care Clinician Plan (PCC) is a statewide managed health care plan with its own network of primary care providers, specialists, and hospitals. The Massachusetts Behavioral Health Partnership provides behavioral health care.

Accountable Care Organizations (ACOs) are specific groups of health care providers such as doctors, hospitals, and others, who work together to coordinate care. One type of ACO works with managed care organizations (MCOs), and community partners provide behavioral health and long-term care services; the other type of ACO is called a primary care ACO, which is a group of primary care providers who work with specialists and hospitals in the MassHealth network. The Massachusetts Behavioral Health Partnership provides behavioral health.

MassHealth policy changes sometimes result in program and funding shifts among MassHealth line items in the state budget. Use caution when comparing these line items from year to year.

Updated, February 2018

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