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If you have any questions regarding the information in CCA’s provider manual, please email Provider Relations at [email protected].

Section 3: Member Eligibility

Member Eligibility Requirements, Appeals & Grievances

1. Senior Care Options Eligibility Requirements

Commonwealth Care Alliance Senior Care Options (SCO) is for elders who:

  • Are age 65 or older
  • Are eligible for MassHealth Standard*
  • Live in the Commonwealth Care Alliance SCO service area
  • Agree to receive all covered health and long term services through Commonwealth Care Alliance

*The SCO program is open to MassHealth Standard members with or without Medicare

The program is open to elders in all living situations, including:

  • Elders living independently
  • Elders living in the community with support services
  • Elders in long term care facilities (the potential member cannot be an inpatient at a chronic or rehabilitative hospital or reside in an intermediate care facility)

2. One Care Eligibility Requirements

Commonwealth Care Alliance One Care is for adults who:

  • Are age 21 through 64 at the time of enrollment
  • Are eligible for MassHealth Standard or CommonHealth
  • Are enrolled in Medicare Parts A and B and eligible for Part D
  • Do not have access to other public or private health insurance that meets basic benefit level requirements
  • Live in the Commonwealth Care Alliance One Care service area
  • Agree to receive all covered medical, behavioral health, and long-term services and supports through Commonwealth Care Alliance

Note: One Care will not currently enroll people who are in a PACE or HCBS Waiver program.