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S 856

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 requires coordinated Medicare-Medicaid systems to guarantee dually eligible patients uninterrupted specialist and hospital care access.

Hearing scheduled for 07/01/2025 from 10:00 AM-12:30 PM in Gardner Auditorium
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Bill Summary · S 856

Legislative bill overview

S 856 requires Massachusetts to establish mechanisms ensuring that individuals eligible for both Medicare and Medicaid (dually eligible beneficiaries) maintain continuous access to specialist and hospital services. The bill addresses gaps that occur when these overlapping insurance programs create administrative barriers or coverage gaps for this vulnerable population.

Why is this important

Dually eligible individuals—typically elderly, disabled, or very low-income—rely on both programs but often face fragmented care, delayed referrals, and coverage disputes between systems. Ensuring continuity directly impacts health outcomes, prevents unnecessary emergency department use, and reduces costs by keeping people in appropriate care settings.

Potential points of contention

  • Cost allocation: Unclear whether the state absorbs costs for services Medicare/Medicaid might otherwise dispute, potentially increasing state healthcare spending
  • Implementation complexity: Creating coordination between federal (Medicare), state (Medicaid), and private insurers requires significant administrative infrastructure and potential regulatory changes
  • Definition specificity: The bill's language on "ensuring access" may be vague regarding what constitutes adequate continuity, leaving enforcement standards unclear
  • Provider burden: New documentation and authorization requirements may fall on hospitals/specialists already operating on thin margins

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

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