MassHealth, administered by the Executive Office of Health and Human Services (EOHHS), delivers care through six genuinely distinct mechanisms rather than a single managed care roster: 15 Accountable Care Partnership Plans (ACPPs), one Managed Care Organization (WellSense Essential MCO), two Primary Care ACOs, the Primary Care Clinician (PCC) Plan, One Care (for younger dual-eligible adults), and Senior Care Options (SCO, for dual-eligible members 65 and older). PACE operates alongside these as a separate, fully integrated program for eligible frail elders. Effective January 1, 2026, One Care and SCO both moved from the CMS Financial Alignment Initiative demonstration model to a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) model, under a new five-year EOHHS contract running through December 31, 2030. The rest of MassHealth runs under the nation's longest continuously operating Section 1115 demonstration, currently authorized through December 31, 2027, with a renewal application under CMS review.
Accountable Care Partnership Plans are MassHealth's dominant managed care vehicle: 15 plans, each a partnership between a MassHealth-contracted health plan and a specific accountable care organization, take full financial risk for their enrollees' physical health, behavioral health, and pharmacy costs. WellSense Essential MCO is currently the only traditional Managed Care Organization, and two Primary Care ACOs, Community Care Cooperative and Revere Health Choice, take on a narrower, primary-care-focused financial arrangement rather than full ACPP-level risk. The Primary Care Clinician (PCC) Plan remains available as a fee-for-service option coordinated by an individual primary care clinician, for members who don't enroll in an ACPP, MCO, or ACO. One Care and Senior Care Options serve dual-eligible members separately from all of the above, outside Medicaid's standard Section 1115/1915(b)/1915(c) waiver framework entirely; One Care serves dual-eligible adults under 65, and Senior Care Options serves dual-eligible members 65 and older.
Long-term services and supports are not part of the standard ACPP or MCO capitated benefit; nursing facility care and most home- and community-based waiver services for the general Medicaid population are paid fee-for-service, outside ACPP and MCO financial risk. For dual-eligible members, long-term services and supports are integrated directly: One Care, Senior Care Options, and PACE each coordinate Medicare and Medicaid services, including long-term care, under one capitated plan.
Partially integrated into managed care
Accountable Care Partnership Plans and WellSense Essential MCO include behavioral health as part of their own capitated benefit, alongside physical health. The Massachusetts Behavioral Health Partnership (MBHP) is a separate, standalone behavioral health carve-out that continues to serve members enrolled in the fee-for-service Primary Care Clinician (PCC) Plan. MBHP's contracted operator is Carelon Behavioral Health.
Carved in
MassHealth has no single statewide pharmacy benefit manager. Each risk-bearing ACPP and MCO contracts independently for its own PBM; Mass General Brigham Health Plan, for example, uses Optum Rx.
Conduent State Healthcare LLC operates MassHealth's Pharmacy Online Processing System (POPS), the system that processes pharmacy drug claim data, under contract with Commonwealth Medicine, a division of UMass Chan Medical School.
Last updated: Aug 29, 2026
289 agency updates tracked for Massachusetts. Available with Pro.
See them with ProGet the daily briefing.