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Stories

What are SCO and One Care?

Diana Balmonte, MS, Geriatric & Long Term Support CoordinatorDiana Balmonte, MS, Geriatric & Long Term Support CoordinatorSenior Care Options (SCO) and One Care are health care programs that are unique to Massachusetts. In 2004 the Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) and MassHealth worked with a consortium of partners and launched SCO and One Care as cost-saving, alternative health care models. These new health care models were designed specifically for dually-enrolled MassHealth recipients (individuals with both MassHealth Standard and Medicare). SCO and One Care differ from traditional  insurance providers by offering comprehensive health care coverage with built-in social support services through a team model.

SCO and One Care differ from traditional  insurance providers by offering comprehensive health care coverage with built-in social support services through a team model. 

As of 2018, MassHealth determined that there are approximately 310,000 dually-eligible individuals in Massachusetts, with 48,684 elders who opted into a SCO, and 20,000 disabled individuals who have opted into a One Care program. MassHealth and EOHHS have noted a steady increase in enrollees since the programs’ implementation. Enrolling in either SCO or One Care is optional. People may choose which eligible SCO or One Care program they wish to enroll in, but must be a patient of a participating Primary Care Physician. 

SCO programs are for Massachusetts residents who are at least 65 years of age, and are enrolled in both MassHealth Standard and Medicare. MassHealth and EOHHS offer SCO as a care model to provide more coordination and management than a typical enrollment in MassHealth and Medicare. SCO combines and expands MassHealth and Medicare benefits and provides the enrolled member with a team of nurses, specialists, and a Geriatric Support Services Coordinator (GSSC). SCO is not available in some parts of the Commonwealth, including some areas of Berkshire County. The care plans that offer SCO programs to residents in the LifePath area are Commonwealth Care Alliance, Fallon Navicare, Senior Whole Health, Tufts Health Plan, and United Health Care. 

One Care is a program for Massachusetts residents who are between the ages of 21 and 64. These individuals must have Medicare Parts A & B, qualify for Medicare Part D (drug coverage), be enrolled in MassHealth Standard or CommonHealth, and cannot be enrolled in the Home and Community-Based Services (HCBS) Waiver. Enrolled One Care members have a team of nurses, specialists, and a Long Term Support Services Coordinator (LTSC). Commonwealth Care Alliance (CCA) and Tufts Health Unify each offer One Care programs in areas served by LifePath.

Both SCO and One Care eliminate copays for medical visits and prescriptions, have no deductibles, and offer free transportation options. Benefits also include behavioral health, physical therapy, dental (expanded coverage beyond MassHealth Standard), and types of durable medical equipment like Personal Emergency Response Systems (PERS) or items like rollators (walkers with wheels and a seat), or grab bars.

LifePath employs Geriatric Services Support Coordinators (GGSC) and Long-Term Support Service Coordinators (LTSC) to provide case management for SCO and One Care enrollees in Franklin and Worcester counties. Our GSSCs and LTSCs assess eligibility for in-home and community services, such as assistance with personal care, homemaking, transportation, public benefits, meals, and access to the community. The GSSC/LTSC will obtain authorization for, procure, and help manage those services according to the enrollees’ needs and preferences, and conduct home visits according to SCO/One Care standards. To learn more or enroll, you may call MassHealth at 800-841-2900, or one of the SCO or One Care programs, mentioned above, that service your area.