Massachusetts Medicaid SCO and One Care 2026 (MassHealth FIDE-SNP)

On January 1, 2026, Massachusetts completed the most significant restructuring of its dual-eligible managed-care landscape since Senior Care Options launched in 2004. Both MassHealth SCO and One Care became Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) under a new five-year EOHHS contract running through December 31, 2030, with a possible five additional years of renewal. CMS sunsetted the Financial Alignment Initiative demonstration that authorized One Care for the previous decade. EOHHS selected six organizations to operate SCO and One Care plans for 2026, replacing a larger prior-year set of plans across both products. Two incumbent plans, Fallon NaviCare and WellSense, exited. Two new entrants, Mass General Brigham Health Plan and Community Care Cooperative, joined. Senior Whole Health rebranded to Molina Healthcare. Commonwealth Care Alliance was acquired by CareSource on April 9, 2025, after a near-insolvency that paused enrollment in November 2024.

For approximately 8,000 MassHealth-only seniors who held SCO coverage without Medicare on December 31, 2025, the transition was abrupt: SCO eligibility now requires both Medicare Parts A and B in addition to MassHealth Standard, and they were transitioned to MassHealth Fee-for-Service on January 1, 2026, losing care coordinators, transportation benefits, OTC allowances, dental enhancements, and integrated authorization. Approximately 3,500 of those 8,000 are eligible for the Senior Buy-In Medicare Savings Program and can re-enroll in SCO once they enroll in Medicare under EOM 25-10. The remaining ~5,000, many of them noncitizens not eligible for premium-free Part A, retain MassHealth Standard via Fee-for-Service but cannot rejoin an SCO until and unless they enroll in Premium Part A or otherwise establish Medicare eligibility.

This guide walks through the post-2026 architecture, the six selected plans plan-by-plan with verified 2026 service areas and CMS Star Ratings, the eligibility coordination changes that determine whether a member can enroll, and the practical decisions families face during the 2026 transition year and beyond.

In This Guide

• The 1/1/2026 FIDE-SNP transition: what changed at the architectural level
• The new five-year EOHHS contract through December 31, 2030
• The six SCO and One Care plans selected for 2026, plan by plan, county by county
• SCO eligibility post-2026: Medicare A+B + MassHealth Standard now required
• One Care eligibility post-2026: Standard or CommonHealth + Original Medicare; direct-with-plan enrollment
• The MassHealth-only SCO disenrollment cohort (8,000) and the EOM 25-10 cohort (10,800), distinct populations
• The CCA acquisition by CareSource and what it means for members
• The Senior Whole Health rebrand to Molina Healthcare
• The plan exits: Fallon NaviCare SCO and WellSense Senior Care Options
• Care coordination: SCO Care Manager versus One Care's Independent Living Long-Term Services and Supports (ILLTSS) Coordinator
• 2026 CMS Star Ratings for each Massachusetts SCO plan
• Three worked examples for affected families
• Common pitfalls and confusions
• Pending policy: the §1115 amendment that would expand SCO to CommonHealth members

The 60-Second Version

• SCO and One Care are MassHealth's two integrated dual-eligible managed-care programs. SCO serves dual-eligibles aged 65 and older; One Care serves dual-eligibles aged 21–64.
• Both transitioned to FIDE-SNPs effective 1/1/2026 under a new five-year EOHHS contract through 12/31/2030.
• CMS sunsetted the Financial Alignment Initiative demonstration on 12/31/2025, forcing One Care to migrate from Medicare-Medicaid Plan (MMP) architecture to Fully Integrated Dual Eligible Special Needs Plan architecture under 42 CFR 422.2.
• EOHHS selected six organizations for both programs: Commonwealth Care Alliance (CCA); Tufts Health Plan / Point32Health; UnitedHealthcare; Senior Whole Health by Molina Healthcare; Mass General Brigham Health Plan; and Community Care Cooperative (C3).
• SCO post-2026 requires Medicare Parts A AND B + MassHealth Standard, pre-2026 MassHealth-only members were disenrolled.
• Approximately 8,000 MassHealth-only SCO members were disenrolled on 1/1/2026 to MassHealth Fee-for-Service. About 3,500 are QMB-eligible and can re-enroll in SCO once they enroll in Medicare under EOM 25-10; the remaining ~5,000 retain Standard via FFS but cannot rejoin SCO without establishing Medicare eligibility.
• One Care post-2026 still accepts both Standard AND CommonHealth members with Original Medicare, ages 21–64 at enrollment.
• One Care enrollment moved from state-facilitated to direct-with-plan in 2026.
• Plans that EXITED the integrated programs: Fallon NaviCare SCO and WellSense Senior Care Options.
• Plans that ENTERED for the first time: Mass General Brigham Health Plan SCO + One Care; Community Care Cooperative (C3), both selected by EOHHS, MGB confirmed operational, C3 launch status pending.
• Senior Whole Health rebranded to Molina Healthcare effective 1/1/2026; Senior Whole Health name retired.
• CCA was acquired by CareSource (Ohio nonprofit) on 4/9/2025 after a $217M reserve shortfall and November 2024 enrollment pause; CCA continues to operate as the SCO/One Care brand within the CareSource family.
• All five SCO plans confirmed operational offer integrated Medicare + MassHealth + plan-enhanced benefits including transportation, OTC, dental enhancements, vision allowances, fitness, and care coordination.
• CMS 2026 Star Ratings for verified Massachusetts SCO plans: Senior Whole Health by Molina = 4.5 stars (highest in MA); CCA = 4.0 stars; Tufts ≈ 4.0 stars (system-wide); UnitedHealthcare = 3.5 stars; new entrants (MGB, C3) have no prior Star Rating.
• One Care includes an Independent Living Long-Term Services and Supports (ILLTSS) Coordinator, a community-based, non-plan-employed advocate preserved from the FAI demonstration.

Why Massachusetts Medicaid SCO and One Care Exist

To understand the post-2026 SCO and One Care landscape, it helps to start with the problem these programs were created to solve.

Dual-eligible individuals, people who qualify for both Medicare and Medicaid, are simultaneously the most expensive and most fragmented population in the American health-care system. Medicare covers acute care (hospital, doctor, prescriptions). Medicaid covers long-term services and supports (nursing-facility care, home- and community-based services, personal care, adult day health). For decades, those two payers operated in parallel and frequently in tension: a Medicare-paid hospital discharge would push an elder into a Medicaid-paid nursing facility because no integrated entity coordinated post-acute care; a Medicaid-paid PCA program would not communicate with the Medicare-paid primary care physician about medication management; a member would receive duplicative paperwork, separate authorization processes, and conflicting care plans.

Massachusetts was an early innovator. Senior Care Options launched in 2004 under a §1115(a) demonstration as one of the first fully integrated capitated dual-eligible programs in the country, alongside Minnesota Senior Health Options. Under the SCO model, a single plan held both a Medicare Advantage contract with CMS and a Medicaid managed-care contract with EOHHS, received capitated payments from both payers, and assumed full or partial financial risk for an integrated benefit package. One member, one plan, one care coordinator.

One Care followed in 2013 under the federal Financial Alignment Initiative, CMS's national demonstration of integrated managed-care for working-age duals. Massachusetts was one of fourteen FAI demonstration states. One Care served dual-eligibles aged 21 through 64, a population with disability profiles distinct from older adults: behavioral health complexity, substance use disorders, physical disabilities, traumatic brain injuries, and the need for community-based supports oriented to recovery and independent living rather than nursing-facility-level long-term care.

The 2026 FIDE-SNP transition is the next architectural step. The FAI demonstration ended December 31, 2025, when CMS sunsetted all capitated FAI demos nationally. States with Medicare-Medicaid Plans (MMPs) had to migrate to D-SNP architecture or default to fee-for-service. Massachusetts chose Fully Integrated Dual Eligible Special Needs Plans, the most-integrated D-SNP variant under 42 CFR 422.2, requiring a single entity to hold both an MA contract with CMS and a Medicaid managed-care contract with the state covering at least primary care, acute care, Medicare cost-sharing, and 180+ days of long-term services and supports including nursing facility services per plan year.

In short: SCO and One Care continue to exist; their architectural foundations changed.

The 1/1/2026 FIDE-SNP Transition Explained

What "FIDE-SNP" means in plain terms: a single corporate entity holds both halves of a member's coverage and receives capitated PMPM payments from both CMS (Medicare side) and EOHHS (Medicaid side). One member ID card. One benefit package. One member-services line. One authorization process. One care coordinator. One appeals process. The plan is at financial risk for both Medicare and Medicaid services.

For SCO, the FIDE-SNP designation was largely architectural: SCO was already a single-entity integrated program operating under a §1115 waiver, and the migration to formal FIDE-SNP status under 42 CFR 422.2 codified its existing structure. The biggest practical change for SCO is the eligibility coordination, Medicare Parts A AND B are now mandatory.

For One Care, the FIDE-SNP designation was more substantive: the program migrated from FAI MMP architecture (a §1115(a) demonstration framework) to a permanent FIDE-SNP framework. The Medicare and Medicaid contracts that previously operated through the FAI demonstration are now standard MA D-SNP and Medicaid managed-care contracts. Enrollment moved from state-facilitated (members were assigned by EOHHS) to direct-with-plan (members enroll directly with the plan they choose).

Several federal rule changes converged on 1/1/2026 to make this transition operative:

• 42 CFR 422.514(h) (CY 2025 MA Final Rule, 4/23/2024) requires "exclusively aligned enrollment" (EAE) for FIDE-SNPs. Members must hold both Medicare and Medicaid coverage from the same parent entity. This is what forced the Medicare A+B + MassHealth Standard requirement for SCO.
• 42 CFR 422.514(h) further requires by 1/1/2027 that MA organizations offering both a D-SNP and an aligned Medicaid MCO in the same service area comply with new alignment rules. Massachusetts's 2026 transition already meets this requirement.
• CMS FAI demonstration termination 12/31/2025, affects One Care directly.

The new EOHHS contracts were signed 6/17/2025 effective 1/1/2026 with an initial five-year term through 12/31/2030 and up to five additional years of renewal in any increment. This is a longer contract horizon than the typical three-year EOHHS managed-care contract, reflecting the architectural complexity of integrated dual-eligible programs and the need for plan operational stability.

Member-facing changes that took effect 1/1/2026:

• Single integrated UCard / Subscriber ID (replacing the prior dual-Member-ID architecture for some plans).
• Prior authorizations linked to old member IDs expired 12/31/2025; new authorizations were automatically generated under new IDs.
• All plans now require Medicare and Medicaid coverage from the same parent entity (EAE).
• For SCO members: Medicare Parts A AND B + MassHealth Standard mandatory.
• For One Care members: enrollment moved from state-facilitated to direct-with-plan; CommonHealth eligibility expressly preserved.

SCO Eligibility Post-2026

Effective 1/1/2026, SCO eligibility requires:

1. Age 65 or older.
2. Enrolled in Medicare Part A AND Part B. This is the new requirement; pre-2026, SCO accepted MassHealth-only seniors. Members eligible for premium-free Part A based on work history qualify; members not eligible for premium-free Part A may enroll in Premium Part A (paying the premium themselves, or having MassHealth pay it through the Senior Buy-In Medicare Savings Program if income-eligible). Senior Buy-In requires income at or below 190% FPL ($2,527/month single in 2026).
3. MassHealth Standard. CommonHealth is not yet an SCO eligibility pathway, but the 10/11/2024 §1115 amendment request seeks to permit MassHealth CommonHealth members to enroll in SCO. CMS approval is pending.
4. Reside in the plan's service area.
5. Not enrolled in another comprehensive health plan.

Excluded from SCO:

• Persons with end-stage renal disease at the time of enrollment.
• Residents of intermediate care facilities for individuals with intellectual disabilities (ICF/IID).
• Chronic / rehabilitation hospital inpatients.

Enrollment process:

• Voluntary; via plan directly, via MassHealth Customer Service (1-800-841-2900), or via 1-800-MEDICARE.
• Early enrollment for 1/1/2026 coverage opened 10/15/2025.
• Effective date generally the first of the month following a notice received by the 20th of the prior month.

Disenrollment rights:

• Any month for any reason. Written notice; if received by the 20th of the month, effective the 1st of the following month (M.G.L. c. 118E § 9D).
• Members may switch to another SCO, to PACE, or to Original Medicare + MassHealth Fee-for-Service.

Massachusetts Medicaid SCO Plans Operating in 2026, Plan-by-Plan

Six organizations were selected by EOHHS for 2026 SCO contracts. Five are confirmed operationally launched as of this guide's verification date; one (Community Care Cooperative) was selected but operational launch status is pending verification.

Commonwealth Care Alliance (CCA) Senior Care Options

• Service area (10 counties): Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
• 2026 CMS Star Rating: 4.0 stars, with 5-star ratings on SNP Care Management, Transitions of Care, and Reducing the Risk of Falling
• Member services: 1-866-610-2273 (TTY 711)
• Enrollment: 1-888-537-5816
• Contract ID: H2225-001-0
• Notable corporate context: CCA was acquired by CareSource (an Ohio nonprofit) on April 9, 2025, after a $217 million reserve shortfall and a MassHealth-imposed enrollment pause in November 2024. CEO Chris Palmieri departed during the financial restructuring. CareSource will operationally support CCA's SCO and One Care products from June 26, 2026, forward. Members may receive correspondence with CareSource branding; the plan continues to operate as Commonwealth Care Alliance under the CareSource family of brands. CCA insures approximately 50,000 dual-eligible Massachusetts residents across SCO and One Care combined.

Tufts Health Plan Senior Care Options (Point32Health)

• Service area: All Massachusetts counties EXCEPT Berkshire, Dukes, Franklin, and Nantucket (effectively 10 counties)
• Plan IDs: H8330-001-0 (Tufts SCO standard); H8330-002-0 (Tufts SCO CW, for individuals at NF level of care)
• 2026 CMS Star Rating: approximately 4.0 stars (system-wide for Point32Health Massachusetts contracts; SCO-specific separate score not isolated in public materials, verify on Medicare Plan Finder)
• 2026 plan-enhanced benefits:
  • $115/quarter OTC Medicare-approved + $235/quarter Medicaid OTC + groceries (no rollover)
  • Transportation: 2 round trips/month, 20 miles each way
  • Dental: includes crowns and implants
  • Vision: $300 eyewear allowance (EyeMed network)
  • YMCA membership (excludes classes)
  • $200/year wellness programs
• Care management: Cityblock Health (Tufts's care management partner)
• Member services: 1-844-226-5162 (main); 1-800-701-9000 (TTY 711)

UnitedHealthcare Senior Care Options

• Service area (9 counties): Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
• Two SCO plan packages:
  • MA-Y001 (H2226-001): Standard SCO for community-dwelling 65+
  • MA-Y002 (H2226-003): SCO NHC, for those at NF level of care
• 2026 CMS Star Rating: 3.5 stars
• Member services: 1-844-812-5967 (TTY 711)

Senior Whole Health by Molina Healthcare

• Service area (10 counties): Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
• 2026 brand change: Effective 1/1/2026, Senior Whole Health operates under the Molina Healthcare brand. The legacy Senior Whole Health name is being retired. Molina acquired SWH in 2018; the 2026 rebrand reflects Molina's broader portfolio consolidation.
• Plan IDs: H2224-001 (SCO HMO D-SNP)
• 2026 CMS Star Rating: 4.5 stars, the highest among Massachusetts SCO plans for 2026
• Notable: SWH-Molina is one of the largest SCO plans by enrollment and the only MA SCO plan rated at 4.5 stars

Mass General Brigham Senior Care Options

• Service area (8 counties): Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk
• Status: NEW NON-INCUMBENT launching 1/1/2026, first SCO product for Mass General Brigham Health Plan
• 2026 CMS Star Rating: No prior Star Rating (new contract)
• Network: Mass General Brigham hospitals (MGH, Brigham and Women's, North Shore, Cooley Dickinson, Wentworth-Douglass, Newton-Wellesley, Salem, Faulkner) plus contracted community providers
• Notable: Brings the largest health-system-affiliated provider network into the integrated dual-eligible market for the first time

Community Care Cooperative (C3) Senior Care Options

• Status: SELECTED for 2026 contract, but operational launch status pending verification at this guide's publication date.
• C3 is the only Massachusetts ACO governed by Federally Qualified Health Centers (FQHCs); has been an MassHealth ACO Partnership Plan participant since the program's inception in 2018.
• Service area: Not publicly published as of verification date. Anticipated to align with C3's existing FQHC ACO footprint.
• Recommendation: Members should verify directly with MassHealth Customer Service (1-800-841-2900) or C3 before assuming enrollment availability.

Plans That Exited SCO for 2026

Fallon Health NaviCare SCO, was an incumbent, NOT selected in the 2024 procurement. Fallon's SCO product ended 12/31/2025. Fallon retains its NaviCare HMO SNP (H8928-001), but this is a Medicare-only D-SNP, not an EOHHS-contracted SCO under the 2026 framework. Members thinking they remain in "SCO" through Fallon NaviCare are mistaken; the integrated MassHealth piece ended 1/1/2026.

WellSense (formerly BMC HealthNet) Senior Care Options, also exited 1/1/2026. WellSense had served Hampden, Plymouth, and Suffolk counties. Members were directed to MassHealth Customer Service (1-800-841-2900) for plan selection during the open enrollment period.

SCO 2026 Service Area Map (Summary)

(✓ = serves county per plan-published 2026 service-area maps; TBD = Community Care Cooperative service area pending public verification)

SCO Benefit Package

All SCO plans cover:

Medicare benefits (Parts A, B, D) at $0 cost-sharing for in-network covered services. This includes hospital admissions, physician visits, prescription drugs on the plan formulary, durable medical equipment, ambulance, post-acute rehabilitation, hospice (Medicare-paid), and preventive services.

MassHealth Standard benefits at $0 cost-sharing. This includes long-term services and supports (LTSS), behavioral health, dental (under MA's enhanced benefit set following the 2024–2025 MassHealth dental restoration), vision, hearing aids, transportation, durable medical equipment beyond Medicare scope, and home health beyond Medicare scope.

Plan-enhanced benefits (vary by plan; all $0 to the member):

• Transportation, typically 2 round trips per month for non-medical, plus unlimited or higher-volume medical transportation; mileage limits vary by plan (Tufts limits to 20 miles each way).
• OTC quarterly allowance, vary $115–$235 per quarter; some plans bifurcate into Medicare-approved and Medicaid OTC categories.
• Vision eyewear allowance, typically $200–$300/year through plan vision networks (EyeMed, Davis, etc.).
• Dental enhancements, crowns, implants, dentures often plan-enhanced beyond MassHealth Standard's coverage scope.
• Fitness center membership, typically YMCA participation (excluding fitness classes in some plans).
• Meal delivery, post-discharge typical (10–14 meals after a hospital admission); some plans provide ongoing chronic-condition meal benefits.
• Wellness rewards programs, Healthy Actions Rewards at SWH/Molina; Tufts wellness program up to $200/year.
• 24/7 nurse line for triage and clinical guidance.

LTSS coordination:

• Personal Care Attendant (PCA) program, preserved consumer-directed model.
• Adult day health (ADH).
• Group adult foster care (GAFC).
• Home health beyond Medicare scope.
• Frail Elder Waiver (FEW) services for members at NF level of care.
• Some plans offer enhanced LTSS package for members at NF-LOC (UHC NHC, SWH NHC, Tufts SCO CW).

The combination of Medicare + Standard + plan-enhanced benefits at $0 member cost-sharing for in-network services is the SCO value proposition. For a senior who was managing Medicare cost-sharing on a $202.90 monthly Part B premium with 20% coinsurance on every service plus separately navigating Standard benefits and PCA approvals, the SCO consolidation alone is materially valuable, before the plan-enhanced benefits.

One Care Eligibility Post-2026

Effective 1/1/2026, One Care eligibility requires:

1. Age 21–64 at the time of enrollment. Members who turn 65 while enrolled may continue in their One Care plan; this continuation is confirmed across every operational plan's published handbook.
2. Eligible for MassHealth Standard OR CommonHealth. CommonHealth eligibility was expressly preserved at the 2026 transition; the 10/11/2024 §1115 amendment further codifies CommonHealth retention.
3. Eligible for and enrolled in Original Medicare (Parts A and B). One Care, like SCO, requires both Medicare parts.
4. No other comprehensive health insurance besides Medicare.
5. Reside in the plan's service area.

Enrollment process:

• Direct with the plan, the major operational change at 1/1/2026. Pre-2026 enrollment was state-facilitated (EOHHS assigned members to plans). Post-2026, members enroll directly with the plan they choose.
• Plans accept enrollment via member services lines, plan websites, and authorized brokers.

Disenrollment rights:

• Any month for any reason; same notice timing as SCO.
• Members may switch to another One Care plan, return to Original Medicare + MassHealth FFS, or, upon turning 65, transition to SCO if otherwise eligible.

One Care Plans Operating in 2026, Plan-by-Plan

EOHHS selected the same six organizations for One Care contracts as for SCO. Confirmed operational One Care plans for 2026:

Commonwealth Care Alliance (CCA) One Care

• Service area (12 counties): Barnstable, Berkshire, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
• Plan ID: H1486
• Member services: 1-855-210-1653 (TTY 711)
• Enrollment: 1-855-431-3556
• Notable: CCA's One Care has the broadest service area of any One Care plan in 2026, 12 of Massachusetts's 14 counties.

Tufts Health One Care (Point32Health)

• Service area (10 counties for 2026, expanded from prior years): Barnstable, Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk, Worcester, plus new for 2026: Hampden and Hampshire
• 2026 new benefits: Instant Savings Card; enhanced dental and vision
• Care management: Cityblock Health
• Member services: 1-855-393-3154 (TTY 711)
• Notable: Tufts Health One Care expanded into Western Massachusetts (Hampden, Hampshire) for 2026, addressing the Pioneer Valley provider network gap.

UnitedHealthcare One Care

• Service area (9 counties): Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
• Two One Care plan packages:
  • MA-Y3 (H4610-001): Standard
  • MA-Y4 (H4610-002): NHC for members at NF level of care
• Member services: 1-844-812-5967 (TTY 711)

Senior Whole Health by Molina One Care

• Selected for One Care contract; service area aligns with the 10-county SCO footprint.
• Members should verify operational launch status with Molina Healthcare directly or via MassHealth Customer Service.

Mass General Brigham One Care

• Service area (8 counties): Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk
• Status: New non-incumbent launching 1/1/2026.
• Eligibility: MassHealth Standard or CommonHealth + Original Medicare; ages 21–64 at enrollment, may continue past 65.
• Benefits: $0 doctor visits, $0 hospital, $0 prescriptions on formulary; dental cleanings, fillings, extractions, root canals, dentures; vision exams + glasses every 2 years; unlimited medical transportation (notable, most plans cap medical transportation); non-medical transportation 2 round trips/month, 50-mile limit (notable, most plans cap at 20 miles); LTSS for home-based assistance; 24/7 nurse advice line.
• Member services: 1-888-403-7567 (TTY 711)

Community Care Cooperative (C3) One Care

• Status: Selected for 2026 contract; operational launch status pending verification.

One Care Benefit Package and the ILLTSS Coordinator

One Care plans cover full Medicare + MassHealth Standard or CommonHealth. The benefit set is broadly similar to SCO but with several One-Care-specific features:

Independent Living Long-Term Services and Supports (ILLTSS) Coordinator, a community-based, non-plan-employed advocate who participates on the member's care team. The ILLTSS Coordinator is typically affiliated with a local Independent Living Center or a community-based disability advocacy organization. The role is required by the EOHHS contract and was preserved through the FIDE-SNP transition from the FAI demonstration. This community-anchored advocacy function is unique to One Care; SCO has no equivalent.

The ILLTSS Coordinator helps the member:

• Navigate plan benefits and authorizations.
• Advocate for community-based services rather than facility-based services where appropriate.
• Coordinate self-directed PCA, behavioral health recovery support, and community supports.
• Communicate with the plan's care manager when there are care-plan disagreements.

This community-anchored advocate model emerged from the disability-rights and recovery-movement origins of One Care. It's a structural acknowledgment that working-age adults with disabilities navigating dual coverage need an advocate not employed by the plan.

Recovery support and peer services, strong emphasis on lived-experience peer support for behavioral health and substance use disorders. One Care plans contract with peer-recovery specialists who themselves have lived experience with the conditions they support.

Behavioral health, substance use disorders, depression, eating disorders, ADHD, mental health conditions, with strong community-based service availability.

LTSS for working-age adults with disabilities, distinct from senior LTSS:

• Flexible community supports, non-medical assistance with activities of daily living, transportation, employment supports.
• Consumer-directed PCA, preserved through the integrated managed-care framework.
• Day habilitation for individuals with intellectual or developmental disabilities (where applicable).
• Crisis intervention services.

The combination of integrated Medicare-Medicaid coverage, peer-led recovery support, and the ILLTSS community advocate makes One Care substantively different from any other Massachusetts coverage option for working-age duals.

The MassHealth-Only Disenrollment (8,000) and the EOM 25-10 Cohort (10,800)

Two distinct populations are often conflated in family-facing materials about the 2026 SCO transition. They are related but not identical.

Population A: SCO-disenrollment cohort (~8,000 members)

These are MassHealth-only seniors (no Medicare) who were enrolled in SCO as of late 2025 and were disenrolled 1/1/2026 because the post-2026 SCO architecture requires Medicare A+B. Per Mass Legal Services' analysis citing MassHealth data:

• Approximately 3,500 are eligible for Senior Buy-In (federal QMB), meaning their income is at or below 190% FPL ($2,527/month single in 2026), making them eligible for Medicare Savings Program coverage that pays the Premium Part A cost. These members can enroll in Medicare A+B (with Senior Buy-In paying premiums) and re-enroll in SCO at any subsequent month.
• Approximately 5,000 are NOT QMB-eligible, typically because they are noncitizens not eligible for premium-free Part A or premium Part A, or because of other categorical exceptions. These members lost SCO enrollment, retained MassHealth Standard via Fee-for-Service, and cannot rejoin an SCO plan unless and until they establish Medicare eligibility through a different pathway.

Population B: EOM 25-10 mandatory-Medicare-enrollment cohort (~10,800 members)

EOM 25-10 (effective June 16, 2025) requires all MassHealth Standard members aged 65 or older with income at or below 190% FPL to enroll in Medicare as a condition of continued MassHealth Standard eligibility. The cohort is approximately 10,800 members. The cohort overlaps Population A but is broader: it includes Standard members who never enrolled in SCO, as well as the SCO-disenrollment members who are QMB-eligible.

Members in either cohort who do not engage with the Medicare enrollment process within the 60-day notice window face MassHealth Standard termination. The UMass Medicare Enrollment Support Project provides assistance with SSA enrollment appointments, including arranging interpreters and helping with paperwork.

What members in Population A lost on 1/1/2026:

• Care coordinator / care manager, every SCO member had a designated point of contact for benefits, authorizations, and care-plan coordination.
• Plan-enhanced benefits, transportation, OTC allowance, dental enhancements, vision enhancements, fitness, meal benefits, wellness programs.
• Single member services contact, replaced by the multiple disconnected MassHealth Customer Service, MassHealth specialty programs, and provider-by-provider authorization processes that characterize Fee-for-Service.
• Integrated authorization process, replaced by separate medical, behavioral health, and LTSS authorization workflows.

What they kept:

• Full MassHealth Standard medical, behavioral health, LTSS, dental, and vision benefits, now via Fee-for-Service.
• PCA, adult day health, FEW eligibility, must be requested through the local Aging Services Access Point (ASAP).

Path back into SCO:

• For QMB-eligible members: enroll in Medicare A+B (Senior Buy-In pays the Part A premium for those who don't qualify for premium-free); contact a 2026 SCO plan and enroll any month.
• For non-QMB members: must establish independent Medicare eligibility (e.g., earning the additional Social Security work credits to qualify for premium-free Part A; or, in some immigration-status changes, gaining access to Premium Part A via the buy-in mechanism).

The "three-fourths non-citizens" framing that has circulated in some 2025 family-facing materials about the SCO transition is not independently verifiable in this guide's research. It may be approximate or interpolated from EOM 25-10 implementation notes; readers should treat the precise non-citizen proportion as uncertain.

CCA's Acquisition by CareSource

In November 2024, MassHealth paused CCA's enrollment after CCA disclosed a $217 million reserve shortfall. The pause was structural, MassHealth's regulator authority over plan financial solvency required intervention before plan operations could continue accepting new members. CCA's CEO Chris Palmieri departed during the financial restructuring.

On April 9, 2025, CareSource, an Ohio-based nonprofit health plan operating Medicaid and Medicare programs across multiple states, completed an acquisition of Commonwealth Care Alliance. The acquisition closed under regulatory approval from EOHHS and the Massachusetts Division of Insurance.

CareSource's operational support for CCA's SCO and One Care products begins June 26, 2026. CCA continues to operate under the Commonwealth Care Alliance brand within the CareSource family of brands. Member ID cards, member services lines, and care coordinator relationships remain under the CCA brand. Members may, however, receive correspondence with CareSource branding for administrative matters, financial communications, and corporate identity references.

CCA insures approximately 50,000 dual-eligible Massachusetts residents across SCO and One Care combined, roughly 60% of the state's One Care enrollment and a meaningful share of SCO enrollment.

For families: The CCA-CareSource acquisition does not require any member action. Members do not need to re-enroll, change plans, or update any documentation. The plan continues to operate under the same EOHHS contract with the same provider network, the same care coordinators, and the same benefit package as before the acquisition. The acquisition stabilizes CCA's financial position; some practitioners have characterized it as the difference between CCA continuing to operate and CCA disappearing entirely.

The Senior Whole Health → Molina Rebrand

Molina Healthcare acquired Senior Whole Health in 2018. Through the 2018–2025 period, the SWH brand operated as a Molina subsidiary with its own brand identity. Effective 1/1/2026, Molina retired the SWH name and consolidated SCO operations under the Molina Healthcare brand.

Member ID cards, member services lines, and care coordinator relationships are now Molina-branded. The contract ID (H2224-001), provider network, and benefit package remain unchanged. Members do not need to re-enroll or take any action.

For the SWH-Molina SCO plan, the 2026 CMS Star Rating is 4.5 stars, the highest among Massachusetts SCO plans. This rating reflects strong performance across CMS's quality measures including SNP Care Management, Member Experience, Care Coordination, and clinical outcomes.

Plan Exits, Fallon NaviCare and WellSense

Fallon NaviCare SCO was an incumbent with a longstanding presence in central Massachusetts. Fallon was not selected in the 2024 EOHHS procurement for 2026 contracts; the Fallon SCO product ended December 31, 2025. Members were notified during the 2025 transition planning process and directed to MassHealth Customer Service for plan selection.

Fallon retains its NaviCare HMO SNP (H8928-001), a Medicare-only D-SNP for dual eligibles. This is not an EOHHS-contracted SCO under the 2026 framework. Members enrolling in Fallon NaviCare HMO SNP receive Medicare Advantage coverage for dual eligibles but do NOT receive integrated MassHealth Standard benefits through the same plan; their MassHealth coverage remains separate via Fee-for-Service or a different managed-care plan.

Members confused about Fallon NaviCare's 2026 status, whether it remains an "SCO", should understand that the integrated MassHealth piece ended 1/1/2026 even if the Medicare D-SNP product continues.

WellSense Senior Care Options (formerly BMC HealthNet Plan) also exited the integrated programs effective 1/1/2026. WellSense had served Hampden, Plymouth, and Suffolk counties. Members were directed to MassHealth Customer Service (1-800-841-2900) for plan selection during the open enrollment period.

For members who did not actively select a new SCO plan during the 2025 open-enrollment period, MassHealth maintained continuity of MassHealth Standard coverage via Fee-for-Service while the member made a plan selection. Members can switch to a 2026 SCO plan any month.

SCO vs. PACE vs. MassHealth Fee-for-Service

These three options for community-based dual-eligibles are routinely conflated. The distinctions:

PACE is the most-integrated option for individuals who meet PACE eligibility (55+, NF-LOC, in PACE service area). SCO is more accessible for community-dwelling 65+ duals who may or may not have NF-LOC functional status. FFS is the residual option for members who don't choose to enroll in either integrated program.

SCO vs. One Care

A member who turns 65 while enrolled in One Care may continue in their One Care plan or transition to SCO. The continuation pathway preserves member relationships with care coordinators and behavioral health providers, especially important for members managing serious mental illness or substance use disorders.

Care Coordination, SCO Care Manager vs. One Care ILLTSS Coordinator

SCO Care Manager:

• Plan-employed; typically registered nurse or licensed social worker.
• Conducts initial and annual comprehensive geriatric assessment.
• Develops individualized plan of care with member, PCP, and interdisciplinary team.
• Coordinates with PCP and specialists.
• Coordinates LTSS, including PCA and FEW services.
• Some plans designate a Geriatric Support Services Coordinator (GSSC) for additional community-based care management.

One Care Care Coordinator + ILLTSS Coordinator:

• Plan-employed Care Coordinator handles plan benefits and authorizations.
• ILLTSS Coordinator is community-based and not plan-employed, a structural advocate for the member.
• Strong recovery and self-direction emphasis.
• Peer-recovery specialists support behavioral health and substance use disorder care.

Interdisciplinary team (both programs):

• Primary care physician.
• RN care manager / care coordinator.
• Behavioral health clinician (more prominent in One Care).
• Pharmacist.
• LTSS coordinator (in One Care, includes the ILLTSS coordinator).
• Care management technician.

Member voice / self-direction:

• Member-driven care plans.
• Right to choose PCP within network.
• Right to consumer-directed PCA via MassHealth PCA program (preserved across both programs).

2026 CMS Star Ratings, Verified Massachusetts SCO Plans

Massachusetts state average for MA contracts in 2026 is approximately 4.0 stars; about 40% of MA contracts nationally earned 4 or more stars.

CMS Star Ratings shape plan economics: 4-star and above plans receive Quality Bonus Payments, which fund enhanced benefits and lower out-of-pocket costs for members. The 4.5-star SWH-Molina rating supports the plan's broad benefit array. The 3.5-star UnitedHealthcare rating affects UHC's QBP eligibility for 2027 and may pressure benefit-package competitiveness.

For families choosing among SCO plans, Star Ratings are one input among several, service area, provider network, specific benefit design, and plan customer service quality also matter. The 5-star sub-measure ratings (e.g., CCA's leadership on SNP Care Management) often matter more for individual members than the overall Star Rating.

Three Worked Examples

The choices and consequences of the 2026 transition come into sharper relief with concrete cases.

Example 1, Carmen Lopez, Springfield, single, 71, full dual-eligible

Carmen lives in a senior-housing apartment in Springfield (Hampden County). She receives $1,800/month in Social Security and has Medicare A+B + MassHealth Standard. She has Type 2 diabetes, hypertension, and early signs of cognitive impairment. She wants to enroll in an SCO that has a strong care coordination program and offers transportation for her medical appointments.

Available SCOs in Hampden County: CCA, Tufts, UHC, SWH/Molina, plus C3 (if launched).

Comparison considerations:

• CCA (4.0 stars): Strong on transitions of care and SNP care management; broad provider network including Baystate Health system.
• Tufts (~4.0 stars): Care management via Cityblock Health, strong dental enhancements, $115/quarter Medicare OTC + $235/quarter Medicaid OTC, transportation 2 round trips/month at 20-mile limit.
• UHC (3.5 stars): Lower Star Rating; broad national provider network; specific Hampden County network varies.
• SWH/Molina (4.5 stars): Highest Star Rating; strong reputation in Western MA; Healthy Actions Rewards.

Practitioner guidance: For Carmen, the SWH/Molina plan offers the strongest CMS-rated quality at a 4.5-star level. Tufts offers stronger dental enhancements that may matter for someone managing diabetes-adjacent oral-health concerns. CCA offers the strongest Transitions of Care program, important for a member with early cognitive decline who may face hospitalizations. Carmen should call SHINE for personalized plan counseling, then call each plan's member services line to verify her PCP is in network and her preferred pharmacy is in network.

Outcome: Carmen selects SWH/Molina based on Star Rating and the Healthy Actions Rewards. She receives a Molina-branded ID card, her existing Baystate Health PCP confirms they are in network, and her care coordinator (RN, geriatric specialty) conducts her initial comprehensive assessment within 30 days of enrollment.

Example 2, Robert Chen, Brookline, MassHealth-only SCO member, 67, no Medicare prior to 1/1/2026

Robert had been a Senior Whole Health SCO member since age 65. He came to the U.S. from Taiwan in 2010 and obtained citizenship in 2018. He had not yet enrolled in Medicare because he believed he did not qualify for premium-free Part A (he had only ~28 quarters of US work history at age 65). His income is $1,650/month from a small Social Security retirement benefit + $200/month from a private pension = $1,850/month total.

1/1/2026 status: Robert was disenrolled from SWH SCO on 1/1/2026 because the post-2026 SCO architecture requires Medicare A+B. He was transitioned to MassHealth Standard via Fee-for-Service.

EOM 25-10 status: Robert's $1,850/month income is below 190% FPL ($2,527/month single in 2026), so he falls within the EOM 25-10 mandatory Medicare enrollment cohort. He receives a 60-day notice from MassHealth requiring Medicare enrollment.

Pathway: Robert is eligible to enroll in Premium Part A (paying the monthly premium for individuals who do not qualify for premium-free) and Part B. Because his income is below 190% FPL, he qualifies for Senior Buy-In (federal QMB), which pays his Part A premium, his Part B premium ($202.90/month in 2026), Medicare deductibles, and coinsurance. The UMass Medicare Enrollment Support Project schedules an SSA appointment for Robert and provides Mandarin-language interpretation.

Re-enrollment in SCO: Once Robert enrolls in Medicare A+B (effective the first of the month following SSA enrollment confirmation), he can re-enroll in any 2026 SCO plan any month. He chooses to re-enroll in SWH/Molina SCO to preserve his existing care coordinator relationship.

Outcome: Robert experiences approximately 4 months of MassHealth Fee-for-Service coverage between 1/1/2026 (SCO disenrollment) and his Medicare effective date (~5/1/2026). During those 4 months, he loses SCO transportation, OTC allowance, dental enhancements, and care coordinator support, but retains MassHealth Standard medical and behavioral health benefits via FFS. He re-enrolls in SWH/Molina SCO effective 5/1/2026 with full benefit restoration.

For non-QMB-eligible members in Robert's circumstances, for example, members whose income exceeds 190% FPL and who therefore cannot have Senior Buy-In pay the Part A premium, or members whose immigration status does not yet qualify them for Premium Part A, the path back into SCO is more constrained, and may require waiting for Social Security work credits to accumulate or for other Medicare-eligibility pathways to open.

Example 3, Maria Rodriguez, Worcester, 32, MassHealth Standard + Medicare due to disability

Maria has been on Social Security Disability Insurance (SSDI) for several years following a serious motor vehicle accident that resulted in a traumatic brain injury and ongoing physical disabilities. She qualifies for Medicare Part A and Part B through the SSDI 24-month waiting period and qualifies for MassHealth Standard via the disability pathway. She manages her care with a primary care physician, a neurologist, a behavioral health clinician, and a personal care attendant.

Pre-2026 status: Maria was enrolled in Tufts Health Unify (the Tufts One Care MMP). The MMP delivered integrated Medicare + MassHealth Standard coverage through a state-facilitated enrollment process.

1/1/2026 status: Tufts Health Unify migrated to Tufts Health One Care under the FIDE-SNP architecture. Maria's enrollment migrated automatically to the new plan. Her ID card was reissued with the new plan branding; her PCP, neurologist, and behavioral health clinician remained in network.

ILLTSS Coordinator role: Maria's ILLTSS Coordinator, affiliated with the Center for Living and Working in Worcester, works with her plan's Care Coordinator to ensure her PCA approval continues uninterrupted and her behavioral health support is maintained. The ILLTSS Coordinator helps Maria advocate for additional flexible community supports approved through her care plan.

2026 enhanced benefits: Tufts Health One Care added an Instant Savings Card and enhanced dental and vision benefits for 2026. Maria uses the Instant Savings Card for over-the-counter pain medications and personal-care items.

Outcome: Maria's 2026 transition is operationally invisible, her plan migration, ID-card reissue, and benefit set update all happen behind the scenes. She experiences the FIDE-SNP transition primarily as the new branding and the 2026 benefit enhancements rather than as a coverage disruption. The ILLTSS Coordinator's continuity is a structural feature that preserves her community-based advocacy regardless of plan-architecture changes.

Common Pitfalls

1. Confusing Fallon NaviCare with an SCO in 2026. Fallon's NaviCare HMO SNP is a Medicare-only D-SNP for 2026, NOT an EOHHS-contracted SCO. Members enrolling in NaviCare for 2026 do not receive integrated MassHealth Standard benefits through the same plan.

2. Believing WellSense SCO still operates. WellSense exited 1/1/2026. Members who do not actively select a new plan default to MassHealth FFS for the Medicaid side and continue with their Medicare Advantage choice or Original Medicare.

3. Not understanding the CCA-CareSource acquisition. CCA continues to operate as the SCO/One Care brand; members do not need to re-enroll. CareSource branding on correspondence is administrative, not a plan change.

4. Confusing the SWH and Molina branding. Senior Whole Health and Molina Healthcare are the same plan as of 1/1/2026. The contract, benefit package, and provider network are unchanged; only the brand changed.

5. Misunderstanding the SCO eligibility coordination change. As of 1/1/2026, SCO requires Medicare Parts A AND B + MassHealth Standard. Pre-2026 MassHealth-only members were disenrolled.

6. Conflating the SCO-disenrollment cohort (8,000) with the EOM 25-10 cohort (10,800). They overlap but are distinct populations. The SCO-disenrollment cohort split roughly 3,500 QMB-eligible / 5,000 non-QMB. The EOM 25-10 cohort is broader, all Standard members 65+ at ≤190% FPL not yet enrolled in Medicare.

7. Treating One Care's age cap as absolute. Members enrolled in One Care before age 65 may continue past 65; new enrollment is 21–64.

8. Not knowing CommonHealth members can enroll in One Care but not yet in SCO. The §1115 amendment request that would expand SCO to CommonHealth members is pending CMS approval as of mid-2026.

9. Missing the One Care direct-with-plan enrollment change. Pre-2026, EOHHS facilitated One Care enrollment. Post-2026, members enroll directly with the plan.

10. Underestimating the ILLTSS Coordinator role. This community-based advocate is structurally distinct from the plan-employed Care Coordinator. Members benefit from understanding both roles and using both effectively.

11. Not verifying that nursing facilities accept the SCO/One Care plan. Provider network adequacy is plan-specific. Members entering NF placement should verify the facility is in their plan's network before admission, or face plan-disenrollment-and-re-enrollment friction.

12. Forgetting that disenrollment is available any month. Members are not locked into their SCO/One Care selection. Switching to another plan, to PACE, or to Original Medicare + MassHealth FFS is available any month with a notice received by the 20th for first-of-next-month effective.

13. Treating the 2026 transition as a one-time event. The §1115 amendment is pending; a new §1115 demonstration extension request is being developed; CMS rule changes for D-SNPs continue. The 2026 architecture will continue to evolve through the 2026–2030 contract term.

Pending Policy and Future Outlook

Several policy developments will continue to shape SCO and One Care after 2026:

§1115 Amendment Request (10/11/2024), pending CMS approval as of mid-2026:

• Permit MassHealth CommonHealth members to enroll in SCO (currently SCO is Standard-only).
• Codify CommonHealth retention in One Care post-1/1/2026.
• Authorize expanded community-living supports.

§1115 Demonstration Extension (2028–2032), public comment period summer 2026:

• Renewal of Massachusetts's broader $67B §1115 waiver.
• Anticipated continuation of ACO Program, Primary Care Sub-Capitation, Behavioral Health Inpatient/Diversionary, Contingency Management, Health-Related Social Needs, Reentry Demonstration.

CMS 2027 D-SNP Integration Deadline (42 CFR 422.514(h)):

• By 1/1/2027, MA organizations offering both a D-SNP and an aligned Medicaid MCO in the same service area must comply with new alignment requirements. Massachusetts's 2026 transition already meets this requirement.

CMS 2026 Star Ratings Overhaul:

• Final rule implements changes to Star Ratings methodology that will affect plan economics for 2027 and beyond. The 4.5-star SWH-Molina, 4.0-star CCA, and ~4.0-star Tufts all retain Quality Bonus Payment eligibility for 2027.

Continued plan-network evolution:

• Plans may continue to refine service areas and provider networks through the contract term.
• New plan entries or exits in subsequent procurement cycles.

How to Choose or Switch Plans

Before choosing:

• Verify your eligibility, Medicare A+B + MassHealth Standard for SCO; Standard or CommonHealth + Medicare for One Care.
• Verify which plans serve your county.
• Verify your PCP, specialists, and preferred pharmacy are in the plan's network.
• If you are facility-bound or anticipate nursing-facility placement, verify the facility accepts the plan.
• Compare plan-enhanced benefits (transportation, OTC, dental, vision, fitness, meal delivery).
• Compare CMS Star Ratings, one input among several.
• Call SHINE for personalized counseling.

To enroll:

• Plan member services line, MassHealth Customer Service (1-800-841-2900), or 1-800-MEDICARE for SCO.
• Plan member services line for One Care (direct-with-plan).
• Effective the first of the month following a notice received by the 20th of the prior month.

To switch:

• Any month, for any reason.
• Notice to the new plan or to MassHealth Customer Service; effective first of next month if notice received by the 20th.
• May switch among SCOs, between SCO and PACE, or to Original Medicare + MassHealth FFS.

Where to Get Help

Government and quasi-government:

• MassHealth Customer Service: 1-800-841-2900 (TTY 1-800-497-4648); Mon–Fri 8am–5pm
• MassOptions: 1-800-243-4636 (referrals to ASAPs and SHINE)
• SHINE Program (Serving the Health Insurance Needs of Everyone): plan counseling, access via MassOptions or local ASAP
• 1-800-MEDICARE for Medicare-side enrollment / disenrollment
• MassHealth Long-Term Care Ombudsman: 617-727-7750 / 617-222-7495
• UMass Medicare Enrollment Support Project (EOM 25-10 assistance): inquire via MassHealth Customer Service or MEC at 1-888-665-9993

Plan member services (SCO):

• Commonwealth Care Alliance SCO: 1-866-610-2273 (TTY 711); enrollment 1-888-537-5816
• Tufts Health Plan SCO: 1-844-226-5162 / 1-800-701-9000 (TTY 711)
• UnitedHealthcare SCO: 1-844-812-5967 (TTY 711)
• Senior Whole Health by Molina: verify with Molina Healthcare directly
• Mass General Brigham SCO: verify with Mass General Brigham Health Plan directly
• Community Care Cooperative: verify operational status with MassHealth Customer Service

Plan member services (One Care):

• Commonwealth Care Alliance One Care: 1-855-210-1653 (TTY 711); enrollment 1-855-431-3556
• Tufts Health One Care: 1-855-393-3154 (TTY 711)
• UnitedHealthcare One Care: 1-844-812-5967 (TTY 711)
• Mass General Brigham One Care: 1-888-403-7567 (TTY 711)
• Senior Whole Health by Molina One Care: verify with Molina Healthcare directly
• Community Care Cooperative One Care: verify operational status with MassHealth Customer Service

Advocacy:

• My Ombudsman (Disability Policy Consortium): 1-855-781-9898 (TTY MassRelay 711), for SCO and One Care members with denials, appeals, grievances, access issues
• Disability Law Center: 617-723-8455 / 1-800-872-9992
• Greater Boston Legal Services: 617-371-1234
• AARP Massachusetts: 1-866-448-3621
• Dignity Alliance Massachusetts
• Mass Senior Care Association: 617-558-0202
• LeadingAge Massachusetts: 781-622-5999
• MA NAELA (National Academy of Elder Law Attorneys, Massachusetts Chapter)

Learn More

• MassHealth Programs Overview
• MassHealth Eligibility & Income Limits
• MassHealth Spousal Impoverishment
• MassHealth Estate Recovery
• MassHealth Personal Needs Allowance
• MassHealth Medically-Needy Spend-Down

Find personalized help navigating 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.