The bill outlines the ongoing efforts of MassHealth to enhance care for adults aged 21-64 who are enrolled in both Medicare and Medicaid through the One Care program. This initiative aims to provide integrated, person-centered care by utilizing contracted managed care entities that deliver comprehensive services. The program has shown promising results, achieving high quality and member experience ratings among Dual Eligible individuals. The Fiscal Year 2025 budget mandates that the Executive Office of Health and Human Services (EOHHS) report to the House and Senate Committees on Ways and Means regarding the number of members served, average expenditures per member, and the number of clients receiving care at skilled nursing facilities.

As of December 2024, there are 41,599 individuals enrolled in One Care plans, which include various care categories. The EOHHS has contracted with three One Care plans, which provide coordinated care covering Medicare and MassHealth services, along with additional support services. The average monthly payment per enrollee for calendar year 2024 is reported at $1,997.67, reflecting the concentration of higher-cost members. The bill also notes that approximately $23.8 million has been withheld for performance on quality measures, which will be distributed to plans meeting specific benchmarks. Additional information about the One Care program can be obtained by contacting Sarah Nordberg at the provided email address.