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SD 1815

An Act ensuring access and continuity of care to specialist and hospital services for dually eligible individuals

194th Legislature (2025-2026) Introduced by Sal DiDomenico

Massachusetts bill establishes healthcare coordination requirements between Medicare and Medicaid to maintain dual-eligible individuals' specialist and hospital service access.

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Bill Summary · SD 1815

Legislative bill overview

Bill SD 1815 addresses healthcare access for "dually eligible" individuals—those who qualify for both Medicare and Medicaid. The bill establishes requirements to ensure these beneficiaries can maintain continuity of care with specialists and hospital services, likely by coordinating between the two insurance systems and preventing coverage gaps during transitions between programs.

Why is this important

Dually eligible individuals are typically elderly or disabled and have complex healthcare needs, making continuity of specialist care critical. Current fragmentation between Medicare and Medicaid systems can result in coverage denials, forced provider changes, and delayed treatments—outcomes that disproportionately harm vulnerable populations.

Potential points of contention

  • Implementation costs: Requiring coordination between federal (Medicare) and state (Medicaid) systems may impose significant administrative and financial burdens on providers and payers
  • Insurance company concerns: Insurers managing dual-eligible plans may resist mandates that limit their ability to control costs through network restrictions or prior authorization requirements
  • Scope ambiguity: The bill's specific mechanisms for ensuring "access and continuity" are not detailed here, leaving questions about what providers must do and what flexibility they retain in coverage decisions

Compiled from official sources — confirm details with the bill’s official record.

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