CCA Coverage Changes and Financial Strain Put Providers on Notice Ahead of 2026
CCA Coverage Changes and Financial Strain Put Providers on Notice Ahead of 2026
Authorizations in place to prevent service disruptions as expanded benefits sunset January 1, 2026
Contracted providers received a notice on December 24 from Commonwealth Care Alliance (CCA) outlining how services will be handled for One Care members as benefit changes take effect January 1, 2026. The guidance arrives as providers across Massachusetts are navigating both significant program changes and heightened financial uncertainty surrounding the plan.
One Care plans will no longer cover certain expanded services, including home care services, beginning in 2026. CCA has stated it is working to transition affected members and identify appropriate alternative services. To prevent immediate disruptions, CCA authorized defined continuity of care periods beginning January 1, 2026.
These continuity of care authorizations were issued to providers via fax, and authorization status may also be verified through the CCA provider portal. Most continuity periods are expected to run through March 31, 2026. CCA has since confirmed that Senior Care Options (SCO) enrollees will also receive continuity of care authorizations, with some approvals extending beyond March 31.
The continuity guidance coincides with broader structural changes underway at CCA, including the transition of One Care to a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) model in 2026. It also follows months of public reporting detailing financial challenges at the organization that have direct implications for contracted providers.
State records and reporting by MassLive and The Boston Globe show that CCA has experienced substantial operating losses in recent years and has fallen out of compliance with solvency reserve requirements tied to its MassHealth contracts. In response, MassHealth imposed a temporary enrollment freeze in late 2024 and required CCA to submit a corrective action plan, citing the need to protect members.
State officials have acknowledged they are developing contingency plans should CCA be unable to stabilize its finances, including identifying vendors that could assume care coordination functions if necessary. Disability advocacy organizations have publicly urged the state to consider temporary receivership as a way to preserve access to care for members with complex needs.
- Retain all continuity of care authorizations, fax confirmations, and portal screenshots.
- Reference approved continuity periods and provider manual language when submitting claims or appeals.
- Escalate unresolved authorization or payment issues promptly and track response timelines.
- Document patterns of delayed payment or inconsistent guidance that threaten service continuity.
Members of the Home Care Alliance of Massachusetts have access to regulatory guidance and advocacy support to elevate reimbursement and authorization concerns. Providers who are not currently members and need assistance navigating these issues are encouraged to contact Leslie Hammond to learn more about joining the Alliance and accessing these resources.
Provider Reference: 2026 CCA SCO & One Care Provider Manual
CCA has released its 2026 Senior Care Options (SCO) and One Care Provider Manual, dated December 12, 2025. The manual serves as the primary operational reference for contracted providers and consolidates guidance on prior authorization requirements, claims and billing procedures, care coordination expectations, and continuity of care policies.
Access the 2026 CCA SCO & One Care Provider Manual
Providers are encouraged to reference the continuity of care provisions in the 2026 manual when communicating with CCA regarding authorizations, claims, or payment disputes during the transition period.