Boston Medical Center HealthNet Plan Selected to Participate in Medicare/Medicaid Dual Eligibles Demonstration

Nov 15, 2012, 17:00 ET from Boston Medical Center (BMC) HealthNet Plan

BOSTON, Nov. 15, 2012 /PRNewswire-USNewswire/ -- Boston Medical Center HealthNet Plan (BMCHP) is pleased to announce that on November 2 it was selected by the Massachusetts Executive Office of Health and Human Services (EOHHS) for contract negotiations to participate in the Massachusetts Medicare-Medicaid Demonstration. BMCHP will now advance to a joint state and federal readiness review process to prepare to serve as an Integrated Care Organization to manage the health care for adults, ages 21-64, who qualify for both Medicaid and Medicare. The dual eligible population covered by this Demonstration is diverse in terms of its health needs with some individuals having extremely complex medical and behavioral health issues.

The federal Centers for Medicare and Medicaid Services (CMS) offered planning grants to 15 states, including Massachusetts through EOHHS, to design innovative approaches to extend integrated, coordinated care to the duals population. Approximately 111,000 individuals are considered eligible for the Demonstration in Massachusetts.   

"Our goals for the Duals Demonstration are improving quality of care, reducing health disparities, eliminating duplication of services and containing costs. We have developed a person-centered approach to meet the unique needs of these individuals, and we look forward to working side by side with them, as well as with health care providers and community support groups across the state," said Scott O'Gorman, President of BMCHP. "Given our 15-year history of delivering quality managed care to MassHealth members, as well as our affiliation with Boston Medical Center where many people who are eligible for the Demonstration seek care, we are uniquely positioned to serve as an Integrated Care Organization. We will implement the systems and services necessary to ensure targeted care for this special population." 

For this Demonstration, BMCHP specifically limited its service area to 10 of Massachusetts' 14 counties in order to ensure appropriate service levels for members. BMCHP has been selected for contract negotiations to operate as an Integrated Care Organization (ICO) in all 10 of those counties: Barnstable, Berkshire, Bristol, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth and Suffolk. ICOs use care management and coordination practices to offer medical, behavioral health and long-term services and supports and to engage members directly in decisions about their care. The ICO develops a network of health care professionals to deliver care, while contracted hospitals, specialists and community agencies provide additional services.  The go-live date scheduled for April 1 is contingent upon successfully meeting the requirements of readiness reviews and executing a three-way contract with CMS and EOHHS.

"Boston Medical Center always has been committed to caring for the unique health needs of these individuals, and we are excited and confident in our role with this innovative and groundbreaking approach to health care delivery," said Kate Walsh, BMC President and CEO.

Founded in 1997 by Boston Medical Center as a not-for-profit managed care organization, BMCHP serves 260,000 members across Massachusetts through three product lines: Medicaid (MassHealth), Commonwealth Care and commercial coverage. The health plan is ranked in the top 10 nationally among Medicaid plans from the National Committee for Quality Assurance (NCQA) in its Medicaid Health Insurance Plan Rankings 2012–2013. In addition, BMCHP has maintained Excellent Accreditation from NCQA for its Massachusetts Medicaid plan since its initial accreditation in 2009. For more information about BMCHP, visit

Contact: Richard Wolosz of Boston Medical Center (BMC) HealthNet Plan, +1-617-748-6364,

SOURCE Boston Medical Center (BMC) HealthNet Plan