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CCA Senior Care Options (HMO Medicaid) (MA) – Disenrollment Form for MassHealth-Only Members (2024)

If you request disenrollment, you must continue to get all medical care from Commonwealth Care Alliance Massachusetts (CCA) Senior Care Options (HMO Medicaid) until the effective date of disenrollment. Contact us to verify your disenrollment before you seek medical services outside of our network. We will notify you of your effective date after we get this form from you.

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