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Financial Alignment Initiative

Recent Posts: 

08/14/15 - The revised CY 2016 Medicare-Medicaid Plan (MMP) Marketing Guidance for California posted on the Information and Guidance for Plans page.

08/13/15 - The CY 2016 MMP Member Handbook (Chapters 4, 8 & 9), Enrollment Form, and Provider & Pharmacy Directory templates for Minnesota posted on the Information and Guidance for Plans page.

08/13/15 - The CY 2016 MMP Annual Notice of Change and Summary of Benefits templates for South Carolina and the Provider & Pharmacy Directory template for Texas posted on the Information and Guidance for Plans page.

08/13/15 - The revised CY 2016 MMP Marketing Guidance for New York posted on the Information and Guidance for Plans page.

08/12/15 - The updated CY 2016 MMP Member Handbook (Chapters 2, 10 & 12), Drug-Only Explanation of Benefits (EOB) and Provider & Pharmacy Directory templates for South Carolina posted on the Information and Guidance for Plans page.

08/12/15 - The CY 2016 MMP Member Handbook (Chapters 3 & 9) templates for New York and the updated Appendix 5: Enrollment guidance for Texas posted on the Information and Guidance for Plans page.

08/12/15 - The CY 2015 Medicare-Medicaid Capitated Financial Alignment Model Reporting Requirements for Illinois posted on the Information and Guidance for Plans page.

08/11/15 - The CY 2016 MMP Marketing Guidance for Michigan, Ohio and South Carolina posted on the Information and Guidance for Plans page.

08/10/15 - The CY 2016 MMP Member Handbook (Chapters 1-3, 5-7, 10-12) templates for Minnesota 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.

 

Demonstrations

CMS is providing an opportunity for all states that are currently participating in the Financial Alignment Initiative to extend the scheduled end dates for demonstrations. CMS has asked that each interested state submit a non-binding letter of intent by September 1, 2015.

Final Memoranda of Understanding (MOU) establishing the parameters of each demonstration may be found at:

Original state proposals and public comments may be found at:

 

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