A Medicare-Medicaid Partnership for Eligible Seniors
SCO is a comprehensive health plan that covers all of the services reimbursable under Medicare and MassHealth through a senior care organization and its network of providers. The Senior Care Options (SCO) program was created to offer seniors aged 65 or older the opportunity to receive quality health care that combines health services with social support services. By coordinating care and specialized geriatric support services, along with respite care for families and caregivers, SCO offers an important advantage for eligible members over traditional fee-for-service care.
Enrollment in this managed care program is voluntary and open to MassHealth Standard members who meet the following criteria:
- are aged 65 or older;
- live at home or in a long-term-care facility (member cannot be an inpatient at a chronic or rehabilitation hospital or reside in an intermediate care facility for mentally retarded);
- are not subject to a six-month deductible period under MassHealth regulations at 130 CMR 520.028;
- are not diagnosed with end-stage renal disease; and
- reside in a geographic area serviced by a SCO organization.
Receiving Care Under SCO
SCO offers seniors the benefits of coordinated care services. Members enrolled in SCO have 24-hour access to care and active involvement in decisions about their health care. SCO members have a primary care physician (PCP) who is affiliated with the senior care organization. The member's primary care physician and a team of nurses, specialists, and a geriatric support services coordinator work with the member (and family members or caregivers, if applicable) to develop a plan of care to specifically address the needs of the member.
Enrolling in SCO
The SCO program currently provides seniors with the option of enrolling in one of five senior care organizations. The four plans available are:
- Commonwealth Care Alliance
- NaviCare (HMO)
- Senior Whole Health
- Tufts Health Plan Senior Care Options
Members can contact the SCO Unit or individual plans to learn more about which plan is best for them and to request an application.
To enroll in SCO, the MassHealth member (or responsible party) must select a senior care organization. The selected organization will assist with completing a SCO enrollment form and selecting a PCP from the available network. The senior care organization then processes the enrollment with MassHealth and, if applicable, with Medicare.
SCO and Providers
MassHealth members enrolled in SCO must receive all health-care services from the senior care organization's network. The only exception to this are emergency situations. For this reason, it is important to always check EVS before providing services to verify if a MassHealth member is enrolled in SCO. If a member is enrolled in SCO, you should contact the senior care organization with which the member is enrolled before providing services.
For Additional SCO Information
Please view SCO Billing FAQs for Providers. If you have additional questions about SCO after reviewing the FAQs, please contact the MassHealth SCO Unit at 1-888-885-0484.
Senior Care Options Brochures
- Commonwealth Care Alliance - Senior Care Options Program (PDF) file size 1MB
- Evercare - Senior Care Options (PDF) file size 69MB
- MassHealth Senior Care Options (PDF)
- NaviCare (HMO) (PDF) file size 1MB
- Senior Whole Health (PDF) file size 2MB
- Tufts Health Plan Senior Care Options file size 1MB file size 2MB
Studies and Reports
- MassHealth SCO Program Evaluation Nursing Facility Entry Rate in CY 2004-2005 Enrollment Cohorts (PDF) | RTF
- MassHealth SCO Program Evaluation Pre-SCO Enrollment Period CY2004 and Post-SCO Enrollment Period CY2005 Nursing Home Entry Rate and Frailty Level Comparisons
- Senior Care Options Evaluation Phase 2: Member Experience Report of Individual Interviews
This information is provided by MassHealth.