Massachusetts

Massachusetts Capitated Financial Alignment Model Demonstration (One Care)

 SPOTLIGHT & RELEASES

Key Dates

August 22, 2012 - CMS and Massachusetts sign MOU

July 16, 2013 - CMS, Massachusetts, and participating plans execute three-way contract

October 1, 2013 - Start of opt-in enrollment

January 1, 2014 - Start of passive enrollment

December 31, 2015 - CMS, Massachusetts, and participating plans execute updated three-way contract

July 5, 2016 - CMS, Massachusetts, and participating plans execute updated three-way contract

June 11, 2018 - CMS, Massachusetts, and participating plans execute updated three-way contract

March 1, 2019 - CMS, Massachusetts, and participating plans execute updated three-way contract

August 1, 2019 - CMS, Massachusetts, and participating plans execute three-way contract extension

August 1, 2020 - CMS, Massachusetts, and participating plans execute three-way contract extension

August 1, 2021 - CMS, Massachusetts, and participating plans execute three-way contract extension

January 1, 2022 - CMS, Massachusetts, and participating plans execute updated three-way contract

June 30, 2023 - CMS, Massachusetts, and participating plans execute updated three-way contract

October 1, 2023 - CMS, Massachusetts, and participating plans execute updated three-way contract

One Care Model

On August 23, 2012, the Centers for Medicare & Medicaid Services (CMS) announced that the Commonwealth of Massachusetts will partner with CMS in the Financial Alignment Initiative to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.

Under the demonstration, also called "One Care: MassHealth plus Medicare," CMS and Massachusetts will contract with "One Care" plans that will coordinate the delivery of and be accountable for all covered Medicare, Medicaid, and expanded services for participating Medicare-Medicaid enrollees in the Commonwealth. 

More information from CMS:

• Fact Sheet
• Frequently Asked Questions (PDF)
• Three-Way Contract (10/01/2023) (PDF)
  • Summary of Contract Changes (10/01/2023) (PDF)
• Three-Way Contract (03/01/2021 (rev. 6/30/2023)) (PDF)
  • Summary of Contract Changes (03/01/2021 (rev. 06/30/2023)) (PDF)
• Three-Way Contract (01/01/2022 (rev. 09/2022)) (PDF)
  • Summary of Contract Changes (01/01/2022 (rev. 09/2022)) (PDF)
• MOU (PDF)
• State Proposal (PDF)
• Beneficiary Experience Research Results for the One Care Demonstration in Massachusetts (02/14/2023) (PDF)
• Fifth (Preliminary) Evaluation Report for the Massachusetts capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (04/12/2023)
  • Findings at a Glance
• Fourth (Preliminary) Evaluation Report from the Massachusetts capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (09/15/2021)
• Third Evaluation Report from the Massachusetts capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (05/24/2019)
• Second Evaluation Report from the Massachusetts capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (05/24/2019)
• First Evaluation Report from the Massachusetts capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (10/20/2017)
  • Appendices on Demographic and Health Conditions (10/20/2017) (PDF)
• Readiness Review Tool (PDF)
• Massachusetts Evaluation Design Plan (PDF)
• Letter of Intent to Extend Scheduled End Date (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 2 (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 3 (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 4 (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 5 (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 6 (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 7 (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 8 (PDF)
• Massachusetts Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 9 (PDF)

Information for Plans:

• All state-specific information and guidance for plans is available on the Information and Guidance for Plans page.

Information for Beneficiaries and Providers:

• Massachusetts One Care Ombudsman Program

Information from the Commonwealth of Massachusetts:

• Consumer Website: One Care: MassHealth plus Medicare
• Integrating Medicare and Medicaid for Dual Eligible Individuals

Funding Support:

• Beneficiary Counseling & Ombudsman Programs

Massachusetts "Duals Demonstration 2.0" Proposal for Public Comment:

The Massachusetts Executive Office of Health and Human Services has submitted for CMS review a proposal for a new demonstration that would include both the One Care demonstration (for dually eligible individuals under age 65) and the Senior Care Options Dual Eligible Specials Needs Plan program (for dually eligible individuals ages 65 and older).

CMS welcomed public input on this proposal, which is available on the Integrated Care Resource Center website, through October 17, 2018.

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