Tufts Health One Care

Plan overview for providers

MassHealth and the Centers for Medicare & Medicaid Services (CMS) launched a collaborative initiative to integrate care for people who are eligible for both Medicare and Medicaid. Through this initiative, called One Care, MassHealth and CMS seek to fully integrate the delivery and financing of Medicare and Medicaid services to this population. WithTufts Health One Care, our Medicare-Medicaid One Care plan for people ages 21 – 64, we provide enrollees with access to One Care's comprehensive care delivery system.

Eligibility

Individuals are eligible for Tufts Health One Care if they are Massachusetts Medicaid beneficiaries between the ages of 21 and 64 who are also eligible for Medicare due to a disability. Approximately 110,000 Massachusetts residents are eligible for the program. CMS and MassHealth jointly determine eligibility.

Benefits

Tufts Health One Care combines Medicare and Medicaid benefits into one expanded benefit package, including community-based long-term services and supports (LTSS), to maximize enrollees’ independence and well-being. Tufts Health One Care includes free coverage for services, such as:

• Community health workers
• Community support services (CSS)
• Day habilitation
• Group adult foster care
• Home care/Homemaker services
• Home health care services
• Home modifications
• Nurse midwife services
• Peer support/Counseling/Navigation
• Personal care assistants
• Program of assertive community treatments (PACT)
• Respite care

Training

CMS and MassHealth require that all providers contracted to serve One Care enrollees receive training on certain elements of the program, covering topics such as an introduction to the program, cultural competence, and contemporary models of disability. Learn about the required provider trainings for Tufts Health One Care or see our frequently asked questions for more information.

Additional resources

• Tufts Health Public Plans Provider Manual
• Provider Resource Guide
• Medical and behavioral health benefit summary grids
• Payment policies
• Insights and Updates for Providers newsletter

For more information about how we can partner with you to serve individuals who are eligible for Tufts Health One Care, call us at 888-257-1985 and ask to speak with a provider services team member.