Financial Alignment Initiative
7/28/14 - The Spanish-language New York Medicare-Medicaid Plan (MMP) Member Handbook Chapter 8 posted on the Information and Guidance for Plans page.
7/28/14 - The California Evaluation Design Plan posted on the Evaluations page.
7/23/14 - The Ohio MMP 2015 Member Handbook, Member ID Card, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, Integrated Denial Notices, Delegated Notices and Annual Notice of Change posted on the Information and Guidance for Plans page.
7/22/14 - The Final Demonstration Agreement posted on the Colorado page.
7/21/14 - The Virginia MMP 2015 Member Handbook, Member ID Card, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, Integrated Denial Notices and Annual Notice of Change posted on the Information and Guidance for Plans page.
7/21/14 - The New York MMP Member Handbook Chapters 2,5, and 7 posted on the Information and Guidance for Plans page.
7/14/14 - The Spanish-language New York MMP Summary of Benefits and List of Covered Drugs posted on the Information and Guidance for Plans page.
7/8/14 - The New York Readiness Review Tool posted on the Readiness Reviews page.
7/3/14 - The scheduled start dates for both opt-in and passive enrollment into New York FIDA Plans have been updated on the New York page.
6/30/14 - The updated Core Reporting Requirement Template for Ohio posted on the Information and Guidance for Plans page.
A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. To begin to address this issue, the Centers for Medicare & Medicaid Services (CMS) will test models with States to better align the financing of these two programs and integrate primary, acute, behavioral health and long-term services and supports for their Medicare-Medicaid enrollees.
- Capitated Model: A State, CMS, and a health plan enter into a three-way contract, and the plan receives a prospective blended payment to provide comprehensive, coordinated care.
- Learn more about the Capitated Model.
- Managed Fee-for-Service (FFS) Model: A State and CMS enter into an agreement by which the state would be eligible to benefit from a portion of savings from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid.
- Learn more about the FFS Model.
Qualifying states have an option to pursue one or both of the capitated or the FFS financial alignment models. In states with approved demonstrations, CMS will test these models over the next several years.
CMS is also working with some states to pursue demonstrations outside the capitated and FFS financial alignment models.
The 15 States that received design contracts under the State Demonstrations to Integrate Care for Dual Eligible Individuals may choose to pursue these models and use their planning contract and stakeholder processes to support the development of the demonstration proposal.
To participate in the Financial Alignment Initiative, each state had to submit a proposal outlining its proposed approach. All proposals were posted for public comments.
When a State meets the standards and conditions for the Financial Alignment Demonstration, CMS and a State will develop a Memorandum of Understanding (MOU) to establish the parameters of the initiative.
Resources for Implementation
Implementation of each demonstration will be a collaborative effort between CMS and the state. CMS has made several resources available to assist states with implementation activities:
- Funding to Support Options Counseling for Medicare-Medicaid Enrollees
- Funding to Support Ombudsman Programs
- Implementation Support for State Demonstrations (application period has closed)
- Integrated Care Resource Center
- Page last Modified: 07/28/2014 10:52 AM
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