> Managed Care Options

Healthcare has changed markedly over the years. In Massachusetts, the approach to Medicare recipients and those considered dual eligible is geared to a model of comprehensive community care. Inter-disciplinary teams work collaboratively to address a consumer’s needs whether it is preventative care, managing chronic illness, or addressing an acute health problem. Some of the options are:

One Care Plan – ICO (Integrated Care Organization)

Mass Health and Medicare have joined together to create the One Care plan. The plan provides individuals a better way to get the care and social services they need. A primary care team of health professionals, along with a Long Term Care Support Services Coordinator (LTSC), will develop an individualized care plan for members that will support their “health, safety, independence and recovery.” Members of the One Care Plan will be connected to resources and community services. This integrated model ensures dually eligible underage individuals have full access to services and are provided high quality care at lower costs.
To enroll into a One Care Plan – ICO, individuals must meet the following criteria:

  • Age 21-64
  • Have both Medicare Part A and B
  • Qualify for Medicare Part D
  • Have Mass Health Standard or CommonHealth
  • Live in Massachusetts and reside in one of the following counties: Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk, Or Worcester
  • Do not qualify for the Home and Community Based Waiver

Individuals interested in enrolling in the One Care Plan can contact Mass Health Customer Service: 1-800-841-2900

Our One Care Plan – ICO Partners are:
Commonwealth Care Alliance (CCA)
Tufts Network Health Unify Plan

Personal Care Attendant (PCA) Program

Individuals who receive Medicare and MassHealth Standard or CommonHealth benefits can exercise choice within the Personal Care Attendant Program to hire their own personal care workers. These workers can be non-relatives or relatives other than spouses, parents, legal guardians or PCA Program Surrogates. A PCA Program Surrogate is a person appointed by a PCA consumer to assist them in managing the PCA Program when they are unable to manage it independently. To qualify for the PCA Program the individual must have a chronic (long term) disabling diagnosis that causes the individual to require physical assistance with two or more activities of daily living. The individual’s primary care physician must authorize the individual to receive PCA services.

To submit a referral for this program, please use the Home Care, Meals on Wheels, and Personal Care Attendant Referral Form

Programs for All Inclusive Care for the Elderly (PACE)

PACE is a program covered by Medicare and Medicaid for older adults and people over age 55 living with disabilities. This program provides community-based care and services to people who otherwise need nursing home level of care. Those enrolled into PACE are cared for by a team of medical professionals who meet daily to coordinate the care. The team develops a comprehensive individualized care plan that is reviewed with the participant and family. The plan includes everything the participant needs to keep them well, including medical, social, and home-based services. PACE was created as a way to provide the consumer, family, caregivers, and professional health care provider’s flexibility to meet the health care needs of the consumer and help them continue to live in the community. PACE services are also available on a private pay basis. To enroll into a PACE program, individuals must meet the following criteria:

  • Be 55 or older
  • Live in the service area of a PACE organization
  • Be able to live safely in the community
  • Must qualify financially by being on Mass Health Standard, be eligible for Mass Health Standard or have the ability to private pay
  • Certified as needing nursing home level of care

Our PACE Partners in our area:
Element Care
Summit Elder Care PACE programs

Senior Care Organizations

Senior Care Organizations (SCO) offer a voluntary Medicare Advantage health plan that combines individual’s Medicare and Mass Health benefits known as Senior Care Options. SCO provides an integrated and complete package of health care and social services for low income seniors over the age of 65. Medical and Non-Medical services are managed by a Registered Nurse and a Geriatric Support Services Coordinator (GSSC) who work in partnership with a medical team to ensure consumers long term care needs are met, and elders can remain living in the community. To enroll into a Senior Care Options program, individuals must meet the following criteria:

  • 65 years of age or older
  • Have both Medicare Part A and B and Mass Health Standard. Seniors who have only Mass Health Standard may be eligible to enroll
  • Do not have End-Stage Renal Disease (ESRD)
  • Live in Massachusetts and reside in one of the following counties: Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk, Or Worcester

Our Senior Care Options partners are:
Commonwealth Care Alliance Senior Care Options
Fallon Community Health Plan NaviCare
Senior Whole Health
Tufts Health Senior Care Option Plan
UnitedHealthcare Senior Care Options