Who can make a referral?
There are several referral pathways:
- A MassHealth Member can refer Self through their ACO plan
- A Family member, Guardian or Community member can make a referral on behalf of a MassHealth Member
- A Health care provider such as a primary care physician or outpatient therapist can make a referral
- Occasionally MassHealth may auto-refer a Member
- For any MassHealth Member who is also a recipient of DMH’s ACCS program, DMH may make a referral
Who is eligible to be enrolled in a Community Partners program?
- Must be a Massachusetts resident
- Must be Medicaid only recipient enrolled in one of the following MassHealth products:
- MassHealth Standard
- MassHealth CommonHealth
- MassHealth CarePlus
- MassHealth Family Assistance
- NOTE: If also a DMH recipient, you may also be enrolled in Medicare and qualify for CP Services.
- Must be enrolled in Medicaid ACO plan
- NOTE: If also a DMH recipient, you qualify for CP Services whether or not you are enrolled in an ACO plan
- For BH CP: must be between 21-65
- NOTE: If also a DMH recipient, you qualify for CP Services even if over 65
- For LTSS CP: must be between 3-64
Who is best served by a BH or LTSS Community Partner program?
A BH CP offers integrated care coordination to individuals who are aged 18-64, have complex behavioral health needs or substance use disorder as well as complex medical needs and chronic health issues and have high acute service utilization (ED visits, inpatient stays) including:
- Bipolar Disorder
- Mood or Personality Disorder
An LTSS CP offers integrated care coordination to individuals who are aged 3 to 64 and have complex LTSS needs, chronic illness, intellectual and developmental disabilities, and/or complex medical needs, including:
- Brain injury or cognitive impairments
- Physical Disabilities
- PCA services
- Use of orthotics, prosthetics, or respiratory equipment
- Intellectual Disabilities and Developmental Disabilities including Autism
- Home Health Aide
- Substance use and recovery
- Mental health concerns
- Heart Disease
Are Medicare recipients eligible for the Community Partner program?
If you are a Medicare recipient and are receiving ACCS (Adult Community Clinical Services) services from DMH, you may be eligible for the Community Partner program if you are not enrolled in another managed care program such as One Care or Senior Care Options (SCO).
If you are receiving ACCS services and are interested in our BH CP services, please speak with your DMH contact.
Am I eligible for Community Partners services if I am in a MassHealth Primary Care Clinician (PCC) plan?
If you are in a PCC Plan through MassHealth, you are not eligible for CP services. You must be in an ACO plan to be eligible. You can contact MassHealth and request to be enrolled in an ACO plan.
How can I tell if MassHealth is my primary or secondary insurance?
If MassHealth is your only insurance, it’s considered your primary insurance. If you also have private health insurance as well as MassHealth, the private health insurance is your primary insurance and MassHealth is your secondary insurance. In addition, if you have buy-in supplemental coverage through MassHealth, MassHealth is not your primary insurance.