State, feds to increase payments to health program for poor and disabled

State and federal officials will raise payments for a troubled program to insure some of Massachusetts' sickest and poorest residents.

The pilot program, known as One Care, lost $54 million in its first 18 months, the Globe reported in August. One Care covers people struggling with poverty and disabilities who qualify for both Medicare, the government program that covers the elderly and disabled, and Medicaid, which covers low-income families and individuals.

State officials said they would boost payments by 8.6 percent this year, and more than 10.5 percent in 2016, as part of a revised payment structure designed to help stabilize the program. Together, the state and federal government will spend nearly $48 million on One Care over the next two years. The bulk of the funding is federal.


The government is contracting with two insurers, Commonwealth Care Alliance of Boston and Tufts Health Plan of Watertown, to carry out the program, which is meant to rein in health care costs through better coordination of services. A third insurer, Fallon Health of Worcester, is dropping out of the program because of financial challenges.

Lois Simon, president of Commonwealth Care Alliance, called the rate increase "really good news." We believe the steps [federal and state officials] are taking to strengthen the financial framework of the One Care plan will enable the [health] plans to successfully provide the array of services members need," she said in a news release.

The state plans to extend the program until at least 2018 to "fully measure and understand" its impact.

"We believe integrated care models are the way to improve quality of care," said Daniel Tsai, assistant secretary of the state Medicaid program, called MassHealth.

Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.