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Financial Alignment Initiative

Recent Posts: 

03/27/15 - The updated Medicare-Medicaid Capitated Financial Alignment Model Reporting Requirements Memo (03/06/15) posted on the Information and Guidance for Plans page.

03/26/15 - The updated Medicare-Medicaid Plan (MMP) Enrollment Technical Guidance (version 2.2) posted on the Information and Guidance for Plans page.

03/19/15 - The Michigan MMP Integrated Denial Notice (IDN), two additional denial notices and the updated Enrollment Guidance for Illinois posted on the Information and Guidance for Plans page.

03/18/15 - The Michigan MI Health Link Provider Frequently Asked Questions (FAQs) posted on the Michigan page. 

03/11/15 - The updated Michigan MMP Identification Card and Texas MMP Drug-Only Explanation of Benefits (EOB) posted on the Information and Guidance for Plans page.

03/04/15 - The Spanish-language Texas MMP CY 2015 Member Handbook (Chapters 4 and 9), IDN, and updated Identification Card posted on the Information and Guidance for Plans page.

02/27/15 - The updated New York Fully Integrated Duals Advantage (FIDA) Plan Delegated Notice (Exhibit 30) posted on the Information and Guidance for Plans page.

02/27/15 - The South Carolina MMP IDN 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.

 

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:

 

Additional Resources 

The Financial Alignment Initiative has two models, the capitated model and managed fee-for-service model. To learn more about enrollment, age, and health risk assessment (HRA) experiences to date for the capitated model visit the resource below: 

 

Information and Guidance for Plans