One Care Transition Planning

Transitioning One Care from Medicare-Medicaid Plans (MMPs) to Dual Eligible Special Needs Plans (D-SNPs)

MassHealth 1115 Demonstration Amendment Request As Posted for Public Comment - October 2024

On October 11, 2024, Massachusetts announced its intent to submit a request to CMS to amend the MassHealth Section 1115 Demonstration. The Amendment Request outlines the specific authorities being requested from CMS including, 1) Require One Care and Senior Care Options (SCO) plans to cover certain expanded and additional services that enable members with disabilities and older adults to live successfully in the community; 2) Implement certain enrollment flexibilities to ensure maximum possible alignment with Medicare enrollments and to prevent or minimize disruption of a member’s managed care enrollment; and 3) Permit eligible individuals with MassHealth CommonHealth to enroll in SCO when they otherwise meet SCO participation requirements. For more information, and to review the Amendment Request, please visit the MassHealth Section 1115 Demonstration Waiver webpage.

Transition Background

In Spring 2022, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule “Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs.” The Final Rule was published in the Federal Register on May 9, 2022 (2022-09375.pdf (govinfo.gov).

The Final Rule included certain flexibilities for Dual Eligible Special Needs Plans (D-SNPs) and a transition for Medicare-Medicaid Plans (MMPs) from Demonstration to D-SNP authority. One Care provides comprehensive integrated care to dual eligible adults with disabilities (ages 21-64 at enrollment) through MMPs. As the Rule requires, EOHHS is planning to transition One Care to a D-SNP platform effective January 1, 2026. The process for developing the Transition Plan in consultation with stakeholders is described in the Initial Transition Plan submitted to CMS.

For reference, see EOHHS comments submitted to CMS on the proposed rule on March 7, 2022.

Initial Plan for Transition Process

September 30, 2022
 

The initial Transition Plan lays out the process EOHHS expects to use to determine the structural, policy, and operational elements of its Transition. This plan will be considered a living document that will be updated and expanded based on the feedback received from stakeholders and CMS. EOHHS is committed to an engagement process with a wide array of stakeholders to promote collaborative discussion on the planning and implementation as it begins its transition planning process.

Stakeholder Engagement

Please visit this page for upcoming public meetings and information related to MassHealth's ongoing engagement with various Stakeholder groups.

Plan Procurement for 2026

Please visit this page for information about procurement for One Care Plans and SCO Plans for coverage beginning in January 2026.

Date published:	September 30, 2022
Last updated:	November 13, 2024