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Financial Alignment Initiative

Recent Posts: 

10/22/14 - The CY 2015 Marketing Guidance for Michigan plans posted on the Information and Guidance for Plans page. 

10/22/14 - The Texas Medicare-Medicaid Plan (MMP) 2015 Member Handbook (Chapters 1-3, 5-8 and 10-12), Member ID Card, List of Covered Drugs, Provider and Pharmacy Directory and Summary of Benefits  posted on the Information and Guidance for Plans page.

10/16/14 - The South Carolina three-way contract posted on the South Carolina page. 

10/16/14 - The Spanish-language New York FIDA Plan 2015 Member Handbook (Chapters 2, 5, 7, 10 & 13) posted on the Information and Guidance for Plans page. 

10/14/14 - The Illinois Medicare-Medicaid Alignment Initiative Provider Frequently Asked Questions (FAQs) posted on the Illinois page. 

10/10/14 - The Michigan Medicare-Medicaid Plan (MMP) 2015 Member Handbook (Chapters 1-3, 5-8 & 10-12), Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, and Member ID Card posted on the Information and Guidance for Plans page.

10/10/14 - The South Carolina MMP 2015 Member Handbook (Chapter 12) and Provider and Pharmacy Directory posted on the Information and Guidance for Plans page.

10/06/14 - The New York FIDA Plan 2015 Member Handbook (Chapters 3, 4 & 9), Member ID Card and Part D Model Transition Letter posted on the Information and Guidance for Plans page.

10/02/14 - The South Carolina MMP 2015 Member Handbook (Chapters 1-3, 6-8, 10 & 11) and Integrated Explanation of Benefits (EOB) Drug-Only Model for South Carolina posted on the Information and Guidance for Plans page.

9/30/14 - The South Carolina MMP 2015 Marketing Guidance and Guidance for South Carolina MMPs on New Marketing Codes and the Release of Model Marketing Materials posted on the Information and Guidance for Plans page.

9/26/14 - The Spanish-language California MMP 2015 Member Handbook, Provider and Pharmacy Directory, Summary of Benefits, List of Covered Drugs, and Annual Notice of Change posted on the Information and Guidance for Plans page.

9/26/14 - The Minnesota 2015 Provider and Pharmacy Directory and List of Covered Drugs posted on the Information and Guidance for Plans page.

 

Overview

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.
  • 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.

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.

 

State Demonstrations

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:

 

Information and Guidance for Plans