Massachusetts Medicaid's two integrated dual-eligible programs, Senior Care Options (SCO) and One Care, both changed on January 1, 2026. The biggest practical change is for SCO: under the new rules, every SCO member must have Medicare Part A and Part B in addition to MassHealth Standard, so members who had SCO with MassHealth only (no Medicare) were moved to MassHealth Fee-for-Service on January 1, 2026, keeping their MassHealth Standard coverage but losing their plan's care coordination and extra benefits. One Care's change was structural: it moved onto an integrated Dual Eligible Special Needs Plan (D-SNP) platform. This guide explains what changed, who runs the plans for 2026, who still qualifies, and the concrete next step for a family caught in the transition.

In This Guide

What Changed on January 1, 2026

On January 1, 2026, One Care moved onto an integrated Dual Eligible Special Needs Plan (D-SNP) platform, and the MassHealth One Care contract requires each plan to operate as a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP), the most-integrated form of dual-eligible Medicare Advantage plan. Under a FIDE-SNP, a single organization holds both the Medicare contract and the MassHealth managed-care contract, so a member gets one plan, one card, one care team, and one set of benefits covering both Medicare and Medicaid services. A FIDE-SNP is defined at 42 CFR 422.2 as a dual-eligible plan whose single entity holds both the Medicare Advantage contract and the state Medicaid managed-care contract, whose state contract covers long-term services and supports including at least 180 days of nursing facility care, and, for 2025 and later plan years, has exclusively aligned enrollment.

For Senior Care Options, the 2026 change that affects real families is the new eligibility rule described below: Medicare Part A and Part B are now mandatory. SCO was already a single integrated program that combines MassHealth and Medicare benefits into one plan with one card and one care team for people aged 65 and above.

For One Care, the change was larger. One Care had operated under the federal Financial Alignment Initiative (FAI) demonstration, a national test of integrated coverage for working-age adults with disabilities. That demonstration, along with the other capitated FAI demonstrations in seven states, sunset at the end of 2025, and CMS moved those plans onto integrated D-SNPs effective January 1, 2026. Massachusetts followed that path rather than letting members fall back to separate Medicare and Medicaid coverage.

The new MassHealth SCO contracts were signed effective June 17, 2025, and the plans could begin providing coverage on or after January 1, 2026.

Why Massachusetts Medicaid SCO and One Care Exist

People who qualify for both Medicare and Medicaid, known as dual eligibles, sit between two payers. Medicare pays for acute care (hospital, doctor, prescriptions); Medicaid pays for long-term services and supports (nursing-facility care, home and community-based services, personal care). For decades the two operated separately, producing duplicate paperwork, separate authorizations, and conflicting care plans.

Massachusetts was an early innovator. Senior Care Options launched in 2004 as one of the first fully integrated, capitated dual-eligible programs in the country, putting a member's Medicare and Medicaid coverage under a single plan with a single care coordinator. One Care followed in 2013 under the Financial Alignment Initiative, serving dual eligibles ages 21 to 64, a population whose needs (behavioral health, physical disabilities, recovery-oriented and community-based supports) differ from those of older adults.

The 2026 transition is the next step in that history. It keeps both programs alive while changing the legal framework underneath them, especially for One Care, whose old demonstration authority was ending.

SCO Eligibility After the Transition

Effective January 1, 2026, MassHealth states SCO eligibility as all of the following:

  1. Age 65 or older.
  2. Enrollment in Medicare Part A and Part B. This is the new rule, which MassHealth attributes to amended state law (M.G.L. Ch. 118E, Sec. 9D). Before 2026, SCO accepted seniors who had MassHealth only. A member who is not entitled to premium-free Part A based on work history can buy into Part A; if income qualifies, MassHealth's QMB Medicare Savings Program pays both the Part A and the Part B premium.
  3. MassHealth Standard, plus qualification for Medicare Part D drug coverage.
  4. Living at home or in a long-term-care facility (not as an inpatient at a chronic or rehabilitation hospital, and not in an intermediate care facility for people with intellectual disabilities).
  5. No six-month MassHealth deductible period.
  6. Residence in an area served by a SCO plan.

The Medicare requirement is what reshaped enrollment. SCO members who lacked both Medicare parts were moved to MassHealth Fee-for-Service on January 1, 2026, keeping their MassHealth Standard benefits but leaving their SCO plan.

Massachusetts runs its Medicare Savings Programs (formerly branded by MassHealth as Senior Buy-In and Buy-In) with no asset test and higher income limits than the federal floor. The QMB tier covers countable income at or below 190% of the federal poverty level, $2,527 per month for one person on the MassHealth chart effective March 1, 2026, and pays the member's Medicare Part A and Part B premiums plus deductibles and coinsurance. Because that limit is applied to countable income after MassHealth's disregards, gross income can be higher and still qualify, so do not rule yourself out on the chart figure alone. That matters here because QMB can pay the Part B premium, which is $202.90 per month in 2026, opening the door back into SCO for a disenrolled member who qualifies.

SCO enrollment runs through the plan, through MassHealth Customer Service at 1-800-841-2900, or through 1-800-MEDICARE. Members may switch to another SCO, to PACE, or to Original Medicare plus MassHealth Fee-for-Service; ask MassHealth Customer Service when a change you request takes effect, since the effective date depends on when your notice reaches them.

The 2026 SCO Plans

Six organizations hold signed MassHealth SCO contracts for 2026, signed effective June 17, 2025 and cleared to provide coverage on or after January 1, 2026: Commonwealth Care Alliance (CCA), Fallon Health, Mass General Brigham Health Plan, Senior Whole Health (selected as Senior Whole Health by Molina Healthcare), Point32Health (Tufts), and UnitedHealthcare.

A few points families ask about most:

  • Fallon Health holds a 2026 SCO contract. Reports during the transition that Fallon left SCO are out of date; Fallon is one of the six signed SCO organizations for 2026.
  • Senior Whole Health now operates under the Molina Healthcare brand. The organization is the same; the brand changed.
  • WellSense (formerly BMC HealthNet Plan) is not among the six. A member whose plan is not on the 2026 list should call MassHealth Customer Service to pick one that is.

SCO plans combine MassHealth Standard and Medicare benefits, including Part D drug coverage, into a single plan with one card and one care team, and people eligible for SCO generally have no or low monthly premiums, no copays, and little to no out-of-pocket costs for most covered services. Plans add their own extras on top, which commonly include transportation, over-the-counter allowances, dental, vision, fitness, and meal benefits; the exact extras and any dollar limits vary by plan and change year to year, so confirm the current details with the plan or on the Mass.gov SCO page before enrolling.

Service areas also vary by plan and county. Rather than relying on a static map, check which plans serve your county directly with MassHealth Customer Service (1-800-841-2900, TDD/TTY 711, Monday to Friday, 8:00 a.m. to 5:00 p.m.) or on the Mass.gov Senior Care Options page.

One Care Eligibility After the Transition

MassHealth states One Care eligibility as:

  1. Age 21 to 64 at the time of enrollment.
  2. A disability.
  3. Medicare Part A and Part B, plus qualification for Medicare Part D drug coverage.
  4. MassHealth Standard or CommonHealth. Unlike SCO, One Care accepts CommonHealth members.
  5. No private health insurance, such as coverage through a job.
  6. No participation in a Home and Community Based Services (HCBS) waiver.
  7. Residence in an area covered by a One Care plan.

That list is stricter than it looks in two places families miss: One Care requires a disability determination, and it is closed to someone already enrolled in an HCBS waiver, even if every other box is ticked.

To join, find your plan on MassHealth's One Care Plans page and contact it directly to enroll.

The 2026 One Care Plans

Five organizations hold signed MassHealth One Care contracts for 2026, signed effective June 17, 2025 and cleared to provide coverage on or after January 1, 2026: Commonwealth Care Alliance (CCA), Mass General Brigham Health Plan, Molina Healthcare, Point32Health (Tufts), and UnitedHealthcare.

One Care plans cover full Medicare plus MassHealth Standard or CommonHealth, with a stronger emphasis on behavioral health, recovery, and community-based supports than SCO. Its distinguishing role, the Independent Living Long-Term Services and Supports (ILLTSS) Coordinator, is described under Care Coordination below.

Service areas and plan-specific benefits vary; confirm coverage in your county with MassHealth Customer Service (1-800-841-2900) or on the Mass.gov One Care page.

Who Was Moved to Fee-for-Service, and the Path Back

The hardest-hit group in this transition was the seniors who had held SCO with MassHealth only and no Medicare. On January 1, 2026, they were moved to MassHealth Fee-for-Service. For a frail older adult, that is a real disruption, not a paperwork change: it can mean losing a trusted care coordinator partway through treatment, losing arranged transportation to dialysis or chemotherapy, and trading a single benefit package for separate Medicare and Medicaid processes. The path back is hardest for members who do not qualify for premium-free Medicare Part A, such as people with limited U.S. work history, because they must first find another way to become Medicare-eligible.

What these members kept: full MassHealth Standard medical, behavioral health, long-term-care, dental, and vision benefits, now delivered through fee-for-service rather than a single plan.

What these members lost: the plan care coordinator, the single member-services line, the integrated authorization process, and plan-enhanced extras such as transportation and over-the-counter allowances.

A separate but related rule, MassHealth Eligibility Operations Memo EOM 25-10, requires MassHealth Standard members age 65 or older with income at or below 190% of the federal poverty level to enroll in Medicare as a condition of keeping MassHealth. MassHealth sends a 60-day notice, and members who genuinely cannot get Medicare do not lose MassHealth.

The path back into SCO:

  • A member who qualifies for MassHealth's QMB Medicare Savings Program (countable income at or below 190% of the federal poverty level, and no asset test) can enroll in Medicare Part A and Part B, with MassHealth paying the premiums, then re-enroll in any 2026 SCO plan in a later month.
  • A member who does not qualify must first establish Medicare eligibility some other way (for example, by earning enough Social Security work credits for premium-free Part A), which can take time.

Massachusetts Medicaid SCO vs. One Care

SCO covers dual eligibles 65 and older with Medicare Part A and B plus MassHealth Standard; One Care covers ages 21 to 64 at the time of enrollment, with Medicare plus Standard or CommonHealth.,

Feature SCO One Care
Age 65+ 21 to 64 at enrollment
MassHealth coverage accepted Standard Standard or CommonHealth
Medicare required Part A and Part B Part A and Part B
Orientation Senior and geriatric care Working-age disability, recovery
Care coordination Plan care manager Plan coordinator plus community ILLTSS Coordinator
Enrollment Plan, MassHealth, or 1-800-MEDICARE Direct with plan

MassHealth states the One Care age rule as 21 to 64 at the time of enrollment and does not publish what happens when a member turns 65 while enrolled, so a member approaching 65 should call MassHealth Customer Service at 1-800-841-2900 to confirm whether to stay in One Care or move to SCO.

SCO vs. PACE vs. Fee-for-Service

SCO requires Medicare Part A and B plus MassHealth Standard and serves adults 65 and older; the alternatives below have different rules.

Feature SCO PACE MassHealth FFS + Medicare
Age 65+ 55+ Any
Nursing-facility level of care required No Yes No
Service-area limited Yes Yes (smaller) No (statewide)
Care coordinator Yes Yes No
Plan-enhanced benefits Yes Built into PACE No
Member ID cards One One Two (Medicare + MassHealth)

PACE (Program of All-Inclusive Care for the Elderly) is the most integrated option for people who meet its eligibility (55+, nursing-facility level of care, in a PACE service area). SCO is more accessible for community-dwelling adults 65 and older. Fee-for-service is the fallback for anyone not enrolled in an integrated program.

Care Coordination

SCO care manager. Plan-employed, usually a registered nurse or social worker; conducts the initial and annual assessment, builds the care plan with the member and primary care physician, and coordinates long-term services and supports.

One Care coordinator plus ILLTSS Coordinator. The plan-employed coordinator handles benefits and authorizations. The ILLTSS Coordinator is community-based and not plan-employed, acting as the member's independent advocate, especially for community-based services and self-direction. Peer-recovery specialists are also common in One Care's behavioral health support.

How to Choose or Switch Plans

Before choosing:

To enroll or switch: contact the plan, MassHealth Customer Service (1-800-841-2900), or 1-800-MEDICARE, and ask when the change you are requesting will take effect.

Worked Examples

Carmen, age 71, Springfield, full dual eligible

Carmen has Medicare Part A and B plus MassHealth Standard, and manages diabetes, hypertension, and early memory loss. Because she already has both Medicare parts, the 2026 SCO rule does not disrupt her: she can pick any SCO serving her county. The practical move is to call SHINE for plan counseling, then confirm her doctor and pharmacy are in each plan's network before choosing.

Robert, age 67, MassHealth-only SCO member with no Medicare before 2026

Robert had SCO through MassHealth only and had not enrolled in Medicare, believing he did not qualify for premium-free Part A. On January 1, 2026, he was moved to MassHealth Fee-for-Service, keeping his Standard benefits but losing his plan's care coordinator and extras. His countable income is below 190% of the federal poverty level ($2,527 per month for one person in 2026), so he qualifies for MassHealth's QMB Medicare Savings Program, which pays his Part A premium and his Part B premium of $202.90 per month., Once he enrolls in Medicare Part A and B, he can re-enroll in an SCO plan in a later month and restore his full benefits. The UMass Medicare Enrollment Support Project and a SHINE counselor can help him schedule the Social Security appointment and arrange interpretation.

Common Pitfalls

  1. Assuming SCO still accepts MassHealth-only seniors. As of January 1, 2026, SCO requires Medicare Part A and Part B plus MassHealth Standard.
  2. Believing Fallon Health left SCO. Fallon holds a signed 2026 SCO contract.
  3. Thinking Senior Whole Health disappeared. It operates under the Molina Healthcare brand for 2026; the plan and network are the same.
  4. Confusing the SCO Medicare rule with EOM 25-10. They overlap but differ: the SCO rule is about staying in an SCO plan; EOM 25-10 is about keeping MassHealth Standard at all for members 65+ with income at or below 190% of the federal poverty level.
  5. Assuming One Care is open at any age. One Care enrollment is limited to ages 21 to 64 at the time of enrollment, so an adult who is 65 or older should look at SCO instead.
  6. Ruling yourself out on the income chart. The 190% figure is applied to countable income after MassHealth's disregards, and MassHealth has had no asset test for Medicare Savings Programs since March 1, 2024, so gross income above $2,527 a month does not automatically mean no.

Where to Get Help

MassHealth Customer Service Enrollment, eligibility, and plan questions, including which plans serve your county. 1-800-841-2900 (TTY 1-800-497-4648) mass.gov/masshealth
MassOptions Referrals to local Aging Services Access Points and to SHINE counselors. 1-800-243-4636 massoptions.org
SHINE (Serving the Health Insurance Needs of Everyone) Free, neutral Medicare and plan counseling; reach it through MassOptions or your local Aging Services Access Point. 1-800-243-4636
1-800-MEDICARE Medicare enrollment and disenrollment, and general Medicare questions. 1-800-633-4227https://www.medicare.gov/talk-to-someone medicare.gov
SCO and One Care plan member services Find each plan's current member-services number on the Mass.gov Senior Care Options and One Care pages, since plan branding and contact lines change year to year. mass.gov/senior-care-options

Frequently Asked Questions

What changed for Massachusetts Medicaid SCO and One Care on January 1, 2026?

Two different things. One Care moved off the federal Financial Alignment Initiative demonstration, which sunset at the end of 2025, onto an integrated D-SNP platform where the MassHealth contract requires each plan to operate as a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP). SCO's change was to eligibility: every SCO member must now have Medicare Part A and Part B in addition to MassHealth Standard.

Who was moved off SCO, and can they get back in?

SCO members who had MassHealth only, without Medicare, were moved to MassHealth Fee-for-Service on January 1, 2026, keeping their Standard benefits. A member whose countable income is at or below 190% of the federal poverty level can have MassHealth's QMB Medicare Savings Program pay the Medicare premiums, enroll in Medicare Part A and B, and then re-enroll in an SCO plan in a later month.

Which organizations run Massachusetts SCO and One Care in 2026?

Six hold 2026 SCO contracts: Commonwealth Care Alliance, Fallon Health, Mass General Brigham Health Plan, Senior Whole Health (under Molina Healthcare), Point32Health (Tufts), and UnitedHealthcare. Five hold 2026 One Care contracts: CCA, Mass General Brigham Health Plan, Molina Healthcare, Point32Health (Tufts), and UnitedHealthcare.

How do SCO and One Care differ?

SCO serves dual eligibles 65 and older who have Medicare Part A and B plus MassHealth Standard, with a senior-care focus. One Care serves dual eligibles ages 21 to 64 at the time of enrollment who have Medicare plus MassHealth Standard or CommonHealth, with a community-based ILLTSS Coordinator and a stronger behavioral-health and recovery emphasis.

How do I choose or switch plans?

Compare the plans serving your county on service area, provider network, and benefits, and call SHINE for free counseling. Enroll or switch through the plan, MassHealth Customer Service (1-800-841-2900), or 1-800-MEDICARE, and ask them for the effective date of the change you request.

Learn More

MedicaidMassHealth Programs OverviewMassachusetts Medicaid (MassHealth) explained: 1634 + medically-needy state, $2,000 asset limit, $72.80 PNA, 50% spousal share, Chapter 197 estate recovery. MedicaidMassHealth Eligibility & Income Limits2026 MassHealth eligibility for seniors and people with disabilities: income limits, asset limits, the medically-needy spend-down, and savings programs. MedicaidMassHealth Spousal ImpoverishmentMassachusetts Medicaid spousal impoverishment in 2026: the 50% CSRA rule, MMMNA $2,705.00-$4,066.50, income-first methodology, and Freiner spousal refusal. MedicaidMassHealth Estate RecoveryMassachusetts Medicaid estate recovery in 2026: the 2024 LTC Act narrowing, the $25,000 auto-waiver, three hardship waiver categories, and probate-only scope. MedicaidMassHealth Personal Needs AllowanceMassachusetts Medicaid personal needs allowance in 2026: the $72.80 MassHealth PNA under 130 CMR 520.026 and how it fits the patient-pay calculation. MedicaidMassHealth Medically-Needy Spend-DownMassachusetts Medicaid medically-needy spend-down 2026: the $522/$650 MNIL, six-month deductible mechanics under 130 CMR 520.028-520.035, and which bills count.
Your next step If you were moved to MassHealth Fee-for-Service or need to choose an SCO or One Care plan, call MassHealth Customer Service at 1-800-841-2900 to confirm which plans serve your county, ask SHINE for free plan counseling through MassOptions at 1-800-243-4636, and find personalized help choosing between Massachusetts Medicaid SCO and One Care at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.