THE VBP Blog
Massachusetts MLTSS: How Integrated Care and Consumer Input Shape the Model
Massachusetts uses integrated programs to coordinate medical care, behavioral health, and long-term services, but recent eligibility and program changes create new consumer considerations.
August 13, 2026 – Massachusetts is an important state to watch in any discussion of managed long-term services and supports (MTLSS) because it has separate integrated-care programs for different age groups. One Care combines Medicare and MassHealth benefits through one plan and one care team for adults with disabilities who are ages 21 through 64 when they enroll. Senior Care Options provides a similar structure for eligible adults age 65 and older. Both programs are intended to reduce fragmentation by coordinating medical care, prescription drugs, behavioral health services, and long-term services and supports through a single organization.
The state is also entering an important new stage in its MLTSS development, with One Care transitioning to a Dual Eligible Special Needs Plan (DSNP). These changes make Massachusetts a valuable case study because one plan and one care team can make services easier to coordinate, but integration only works when consumers understand their options, can maintain access to trusted providers, and do not experience disruptions as programs and eligibility rules change.
What Massachusetts’ MLTSS Programs Are and Who They Serve
Unlike Pennsylvania, Massachusetts does not rely on one primary MLTSS program for all eligible populations. Instead, the state uses separate models based largely on a person’s age, Medicare eligibility, MassHealth coverage, and level of care needs. The two main programs are One Care and Senior Care Options, with the Program of All-Inclusive Care for the Elderly, or PACE, offering another option for certain adults who need nursing-home-level care.
One Care primarily serves adults ages 21 through 64 who have a disability and are enrolled in Medicare Parts A and B, qualify for Medicare Part D, and have MassHealth Standard or CommonHealth. Members generally cannot have private comprehensive health insurance or participate in a Home and Community-Based Services (HCBS) waiver, and a One Care plan must operate in their area. The program brings Medicare and MassHealth benefits together under one plan with a care coordinator available to help members navigate their needs.
Senior Care Options offers a similar integrated structure for adults age 65 and older. Beginning January 1, 2026, members must have Medicare Parts A and B, qualify for Part D, and have MassHealth Standard. Eligible consumers may live at home or in a long-term care facility, but they must reside within a SCO plan’s service area.
It is important to note that enrollment in both One Care and SCO is voluntary, allowing eligible consumers to decide whether an integrated plan is right for them and to disenroll if their needs or preferences change. Massachusetts also offers PACE to qualifying adults age 55 and older who meet nursing facility level-of-care requirements, live within a PACE organization’s service area, and can live safely in the community.
From a consumer perspective, these separate programs offer meaningful choices and models tailored to different needs. However, the distinctions among One Care, SCO, PACE, HCBS waivers, and regular MassHealth, as well as their varying availability, can also make it difficult for consumers and families to determine which pathway offers the best fit for their needs.
How Consumers Enter the Programs and Where Friction Begins
The enrollment process depends on which program a consumer chooses. Eligible individuals can compare the One Care or Senior Care Options plans available in their county and enroll in a participating plan that serves their area. Enrollment in both programs is voluntary, which gives consumers more control than a mandatory MLTSS model.
However, voluntary participation does not always mean consumers actively select a plan on their own. Some eligible MassHealth members may be automatically assigned to a One Care plan unless they choose another plan. Automatic assignment may connect people to integrated care who might otherwise miss the opportunity, but it also places responsibility on consumers to understand enrollment notices and act within the required timeframe. For people managing disabilities, complex health needs, or limited access to enrollment assistance, that can create confusion.
Geography and provider networks can also create additional friction. One Care, SCO, and PACE plans operate only in designated service areas, so available options depend on where a person lives. Before enrolling, consumers must determine whether their doctors, specialists, pharmacies, personal care providers, and other trusted supports participate in a plan’s network. The promise of one plan and one care team can be valuable, but only when consumers receive clear information, and can select a program that preserves access to the people and services they already rely on and feel comfortable with. From a consumer advocate’s perspective, Massachusetts offers meaningful choice, but that choice is only effective when enrollment materials are understandable, plan comparisons are manageable, and help is available before coverage changes.
What Massachusetts Gets Right
Massachusetts gets several important things right in its approach to MLTSS. Both One Care and Senior Care Options are designed to bring Medicare and MassHealth benefits together through an integrated care system. Members also have access to a care coordinator who can help organize medical care, behavioral health services, and long-term services and supports. For people who might otherwise have to navigate multiple agencies and benefit systems on their own, that level of integration can reduce confusion and make it clearer who is responsible for helping their care work together.
The state also preserves more consumer choice than mandatory MLTSS models. Enrollment in One Care and SCO is voluntary, and eligible consumers can compare plans available in their area. Massachusetts also offers PACE as another option for certain adults age 55 and older who meet nursing facility level-of-care requirements, though there are some drawbacks with a program like this.
Massachusetts incorporates value-based payment into One Care and Senior Care Options first through capitation. Plans receive prospective per-member, per-month payments to cover a defined package of services and assume financial responsibility when the cost of members’ care exceeds those payments. Capitation is considered a population-based form of value-based payment because it moves away from paying separately for each service and gives plans greater accountability for managing the total cost and coordination of care. However, capitation alone does not guarantee quality and can create incentives to limit services unless it is paired with strong access standards, performance measurement, and consumer protections.
MassHealth also monitors One Care and SCO plans through its managed care quality framework and asked bidders during the 2026 procurement to submit information about their alternative payment arrangements. However, publicly available materials do not identify a fixed percentage of LTSS provider payments that must flow through VBP arrangements, as Pennsylvania requires under Community HealthChoices.
Another positive thing Massachusetts is doing, is supporting accountability through several oversight tools. One Care and SCO plans undergo external quality review focused on the quality, timeliness, and accessibility of services. Plans must also use certified vendors to administer CAHPS surveys, which provide direct information about how members experience their care. This is important in MLTSS because claims and administrative reports cannot fully show whether consumers can reach their care coordinators, access approved services, and how they actually feel about the care they are receiving.
Where the Model Falls Short
While there are positives in Massachusetts, the model still has limitations. The state offers multiple integrated-care pathways, but the differences among One Care, SCO, PACE, HCBS waivers, and regular MassHealth can be difficult for consumers and families to understand. Plan availability also varies by county, so a person’s choices depend heavily on where they live.
In addition, the changes to the program occurring in 2026 highlight how policy decisions can create disruption even within a mature care system. Massachusetts’ integrated-care model entered a new phase on January 1, 2026, when One Care transitioned from the federal Medicare-Medicaid Plan demonstration to a D-SNP structure. The transition required new contracts, readiness reviews, and operational requirements. From a consumer advocate’s perspective, the key question is whether the State’s commitments translate into continuity of coverage, services, providers, and member protections during and after the transition.
From a consumer perspective, Massachusetts has built a thoughtful model that recognizes the value of integration, voluntary enrollment, and direct consumer input. But having one plan and one care team does not automatically create a seamless experience. The model works only when consumers can understand their choices, maintain trusted providers, receive services without interruption.
Advocate’s Perspective
Massachusetts has built one of the more thoughtful MLTSS models by integrating Medicare, MassHealth, behavioral health, and long-term services through One Care and Senior Care Options. Voluntary enrollment, care coordination, CAHPS surveys, and plan-level VBP incentives are all meaningful strengths. Still, integration only matters if consumers experience better access, clearer communication, and fewer disruptions in care. The state’s multiple program pathways, county-based plan availability, and changing eligibility rules can make the system difficult to understand, while the 2026 One Care transition adds new questions about continuity of providers, benefits, and member protections. As the models continue to evolve, consumer choice and feedback should remain central.
Onward!
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.
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