One Care: MassHealth plus Medicare

Introducing One Care: MassHealth plus Medicare

The Massachusetts Duals Demonstration is now called One Care: MassHealth plus Medicare.  One Care is the new health care option for people with disabilities. One Care offers a better, simpler way for people to get the care they need. To join One Care, a person must be eligible for both MassHealth and Medicare and be 21 to 64 years old.

Questions and Answers About One Care

Q. What is One Care?
A.  One Care is a new option for how you receive your MassHealth and Medicare benefits. One Care makes it easier to get all of the services you need. It will let you get your MassHealth and Medicare benefits from a single plan called a One Care plan.

Q. Why are MassHealth and Medicare offering One Care?
A.  To help your MassHealth and Medicare benefits work together for you.

Q. Who can join One Care?
A.  If you are currently have MassHealth and Medicare benefits work better together for you.

Q. Why should I think about joining a One Care plan?
A.  It’s a simpler way to coordinate all of your care, keep the care you already have and get the services that are right for you.

Q. How do I join a One care plan?
A. Call MassHealth Customer Service and someone will help you. If you are eligible, you can also fill out the paperwork that MassHealth sends you in the mail.

Q. What if I join and then change my mind?
A. Visit our website
Email: OneCare@State.MA.US

Introduction To One Care Webinar
MassHealth created this webinar to help One Care plans and their network providers understand the basics of One Care. On the webinar, Robin Callahan, MassHealth Deputy Medicaid Director for Policy and Programs, discusses the populations that are eligible for One Care, the enrollment process, services provided, and how the program will operate.

Background

Massachusetts’ reform efforts include initiatives to develop patient-centered medical homes, bundled payments, accountable care organizations (ACOs), and pending state legislation to promote a multi-payer transition to the use of ACOs

Starting in 2013, approximately 110,000 dual eligibles in Massachusetts, ages 21-64 years who quality for both Medicaid and Medicare, will be included in a demonstration which will combine health care services and long-term supports and services (LTSS) into one integrated care organization (ICO). Individuals will be able to opt out if they want to remain with the present fee-for-service system. The ICOs will enter into three-way contracts with Medicare and Medicaid. They will receive an annual, blended capitated dollar amount for health care and LTSS per dual eligible. This demonstration, termed Duals, is intended to lower the rising costs of Medicaid and Medicare and improve health outcomes by coordinating care for this population.

MassHealth recently selected six organizations to act as Integrated Care Organizations (ICOs). A readiness review evaluates the ICO‘s ability to perform effectively. The ICOs include Blue Care (Blue Cross and Blue Shield of Massachusetts & Value Options); Boston Medical Center HealthNet Plan (BMCHP), Commonwealth Care Alliance (CCA), Fallon Total Care, LLC (FTC) – until 9/30/2015, Neighborhood Health Plan (NHP), and Network Health, LLC.(division of Tufts Health Care).

Integrated Care Organizations with Corresponding Service Regions  – Each ICO covers a range of geographical areas in Massachusetts.
For quality oversight, MassHealth has recently announced several implementation activities:

  • Implementation Council, which will review progress and outcomes of demonstration and advise EOHHS.
  • Ombudsperson role; the ombudsperson will track and report complaints and issues to the ICO s(although independent of the ICO), Implementation Council, and senior leadership
  • Host additional meetings to further develop the project.

Additional information:

For further information, please contact by email at OneCare@State.MA.US

 

 

Fact Sheet last updated on: 8/31/2016