Financial Alignment Initiative (FAI)
SPOTLIGHT & RELEASES
If you are looking for information and guidance for Medicare-Medicaid Plans (MMPs) participating in the Financial Alignment Initiative capitated model demonstrations and the Minnesota Demonstration to Integrate Care for Dual Eligibles, go to the Information and Guidance for Plans webpage.
1/29/2023: (NY page)
CMS released the revised (10/2023) Memorandum of Understanding (MOU) for the New York Integrated Appeals and Grievances demonstration under the Medicare-Medicaid Financial Alignment Initiative extending the demonstration through 12/31/2025.
CMS released the Michigan Three-Way Contract & associated Summary of Changes (effective 01/01/2023), & the Texas Three-Way Contract Amendment & associated Summary of Changes (effective 12/01/2023).
(WA page): CMS and Washington extend Washington managed fee-for-service model demonstration through December 31, 2024, and published the Fifth Final Demonstration Agreement Amendment.
(Evaluations, NY, RI, SC, & TX pages): CMS released the Third Brief Evaluation Report for the New York Integrated Appeals and Grievances demonstration, the Third Evaluation Reports for the Rhode Island (RI) & South Carolina (SC) capitated model demonstration, & the Preliminary Third Evaluation Report for the Texas (TX) capitated model demonstration, under the Medicare-Medicaid Financial Alignment Initiative along with associated Findings At-A-Glance for RI, SC, & TX.
CMS released the Beneficiary Experience Research Results for the Integrated Appeals and Grievances Demonstration in New York (10/01/2022).
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 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 managed fee-for-service model.
Qualifying states have an option to pursue one or both of the capitated or the managed fee-for-service 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 managed fee-for-service financial alignment models.
CMS is providing an opportunity for three demonstration states with current end dates of December 31, 2018 -- Massachusetts, Minnesota, and Washington -- to extend the scheduled end dates for the demonstrations until December 31, 2020.
CMS is providing an opportunity for all states that are currently participating in the Financial Alignment Initiative to extend the scheduled end dates for the demonstrations.
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:
The Financial Alignment Initiative has two models, the capitated model and managed fee-for-service model. To learn more about enrollee experiences with the capitated and managed fee-for-service model demonstrations to date visit the resource below:
To view performance data on care coordination activities and experiences in the capitated model, visit the resource below:
Please visit Information and Guidance for Plans to learn more about information and guidance for Medicare-Medicaid Plans (MMPs) participating in the capitated model demonstrations and the Minnesota Demonstration to Integrate Care for Dual Eligibles in the areas of:
- Application & Annual Requirements
- Reporting Requirements
- Audit Programs
- Encounter Data Reporting
- Marketing Information & Resources
- Quality Withhold Methodology & Technical Notes
- Chronic Care Improvement Programs & Quality Improvement Projects