Patrick Administration Announces New ‘One Care’ Health Plan to Serve Dual Eligible Individuals in Massachusetts
Contracts signed with three health organizations to provide integrated care options to individuals eligible for both Medicaid and Medicare
BOSTON — The Patrick Administration today announced three health plans have signed contracts to participate in One Care, a new, integrated health care pilot that will better serve adults with disabilities, ages 21-64 who receive both MassHealth and Medicare benefits. The program builds on the Patrick Administration’s health care cost containment efforts, by providing better coordination of care for this population through global payments and personalized services.
Participating health plans in One Care include Commonwealth Care Alliance, Fallon Total Care, and Network Health. Massachusetts Health and Human Services (HHS) and the federal Centers for Medicare and Medicaid Services (CMS), will jointly administer the program. HHS estimates that approximately 90,000 individuals will be eligible to enroll in One Care beginning in October 2013.
“With the support of the Obama Administration and our participating health plans, Massachusetts is leading the way on reforming the way we provide care to our most vulnerable,” said Governor Deval Patrick. “One Care will help residents with complex needs get access to the high quality, integrated care they deserve, while removing obstacles to access.”
“The organizations participating in One Care have shown a high degree of collaboration, innovation, and commitment to serving our members under this new integrated care model,” said HHS Secretary John Polanowicz. “I look forward to working with them to strengthen outcomes for this population, while also reducing health care costs.”
One Care was developed by the Patrick Administration to improve care and contain cost for persons with disabilities who are dual eligible for Medicaid and Medicare. Massachusetts was the first state in the nation to receive approval from the Obama Administration to move forward with the program, which is supported by funding in the Affordable Care Act.
One Care is designed to improve coordination of services provided to these individuals; the majority of whom have extremely complex medical care needs. The One Care program will also offer services that are personalized to an individual’s needs and preferences; focus on independent living and community-based supports; improve functional and health outcomes for individuals; and help reduce undesirable cost-drivers such as potentially unnecessary emergency room use, readmissions, facility-based care, and unmanaged chronic diseases.
Under three-way contracts with HHS and CMS, One Care plans will receive a combined global payment from the federal and state governments to provide all the services of Medicare Parts A, B and D, and MassHealth. Until now, these services have only been available to individuals on a non-coordinated, fee-for-service basis.
One Care plans will also offer behavioral health and community support services that are not currently covered by either program. These are services such as peer supports, home care services, non-medical transportation, access to community health workers, and the behavioral health community supports.
The plans will begin accepting enrollments effective October 1, 2013, pending successful completion of a joint state-federal readiness review. MassHealth is launching a public awareness campaign to help inform the public about One Care and members who can enroll in One Care will start to receive mailings in September informing them of the opportunity.
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