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.
04/12/2023: (CA, IL, MA, MI, NY, OH, RI, SC, & TX pages)
CMS released Medicare-Medicaid Plan Quality Withhold Analysis Results for model demonstrations in California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, & Texas under the Medicare-Medicaid Financial Alignment Initiative.
04/12/2023: (Evaluations, CA, IL, MA, NY, & WA pages)
CMS released Evaluation & Cost Savings Reports, with associated Findings at a Glance, for model demonstrations in California, Illinois, Massachusetts, New York, & Washington under the Medicare-Medicaid Financial Alignment Initiative.
(Capitated Model page): CMS released the 2023 MMP Performance Data Technical Notes & MMP Performance Data File.
(NY page): CMS released the Three-Way Contract Amendment & Summary of Contract Changes (effective 01/01/2021) for the NY FIDA-IDD Demonstration under the Medicare-Medicaid Financial Alignment Initiative.
02/14/2023: (MA page)
CMS releases Beneficiary Experience Research Results for the One Care Demonstration in Massachusetts.
02/08/2023: (MN page)
CMS and Minnesota sign third MOU Extension, extending demonstration through December 31, 2023, on September 29, 2020.
OverviewA 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.
DemonstrationsCMS 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.
Resources for ImplementationImplementation 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 ResourcesThe 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