Capitated Model




Under the capitated model, the Centers for Medicare & Medicaid Services (CMS), a state, and a health plan enter into a three-way contract to provide comprehensive, coordinated care.

In the capitated model, CMS and the state will pay each health plan a prospective capitation payment. More information on rate setting:

Medicare-Medicaid Plan Performance Data

Under the capitated model, CMS is collecting a variety of measures that examine plan performance and the quality of care provided to enrollees. The Medicare-Medicaid Plan (MMP) performance data published here represent currently available data on MMP performance on certain Medicare Parts C and D quality measures as well as select CMS core and state-specific measures that MMPs are required to report.

For additional information on the longer term vision for a quality ratings strategy and the way that information on MMP performance will be publicly reported during the interim period see:  

State Demonstrations

To participate in the Financial Alignment Initiative, each state had to submit a proposal outlining its proposed approach. States interested in the new financial alignment opportunities were required to submit a letter of intent by October 1, 2011. When a proposal meets the standards and conditions for the Financial Alignment Initiative, CMS and a state will develop a memorandum of understanding (MOU) to establish the parameters of the demonstration. 

Prior to enrolling or marketing under the capitated model, each health plan must pass a readiness review.

Visit these pages for more information about CMS approved demonstrations in specific states:

For more information, please email

Page Last Modified:
01/09/2020 02:52 AM