Fact Sheets

Funding Opportunity: Support for Demonstration Ombudsman Programs Serving Medicare-Medicaid Enrollees

Funding Opportunity: Support for Demonstration Ombudsman Programs Serving Medicare-Medicaid Enrollees

On June 27, 2013, the Department of Health and Human Services (HHS) released a Funding Opportunity Announcement designed to support states in providing Medicare-Medicaid enrollees with more person-centered, coordinated care through Demonstration Ombudsman Programs. Through this new opportunity, states can apply for funding to develop independent Demonstration Ombudsman Programs to support their current demonstrations through the Financial Alignment initiative. These programs will provide beneficiaries with access to new resources and person-centered assistance in resolving issues related to the demonstration. These programs will also monitor beneficiary experience and offer recommendations to the Centers for Medicare & Medicaid Services (CMS), the states, and participating plans on how the beneficiary experience could be improved.

The Financial Alignment Initiative seeks to provide Medicare-Medicaid enrollees with a better care experience by offering a person-centered, integrated care program that provides a more easily navigable and seamless path to all covered Medicare and Medicaid services. Through the Demonstration, CMS will evaluate the effectiveness of two models:

  1. Managed Fee-for-Service in which a state and CMS enter into an agreement by which the state would be eligible to benefit from savings resulting from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid; and  
  2. Capitated Model in which a state and CMS contract with health plans or other qualified entities that receive a prospective, blended payment to provide enrolled Medicare-Medicaid enrollees with coordinated care.

CMS has signed Memoranda of Understandings (MOUs) with six states to begin Financial Alignment demonstrations. Five states are participating in the capitated model: Massachusetts, Ohio, Illinois, California, and Virginia. One state (Washington) is participating in the Managed Fee for Service Model.  

Purpose of Funds
This Funding Opportunity will provide financial assistance over a three-year period to states to plan, develop and provide Demonstration Ombudsman Program services to individuals who participate in the Financial Alignment model. These programs are designed:
        •     To ensure that individual beneficiaries have access to person-centered assistance in resolving any problems or questions related to the Demonstration.
        •     To inform states, Plans, CMS, and other stakeholders regarding beneficiary experience with the Plans or managed fee for service networks.
        •     To recommend areas of improvement in States’ Financial Alignment Initiatives.

States with an approved MOU to participate in the Financial Alignment Initiative are eligible to receive funding from this funding opportunity.  

Funding Amounts
The total amount of federal funds available is anticipated to be about $12 million over three years. CMS anticipates making cooperative agreement awards beginning this fall CMS will be involved in award activities funded through the cooperative agreements.

Application Process
States submit applications to CMS in three rounds (see Key Dates below). Award scores are based on:
        •     Proposed Approach (30 points)
        •     Organizational Capacity and Management Plan (25 points)
        •     Evaluation and Reporting  (20 points)
        •     Budget and Budget Narrative (25 points)
A more detailed description of these criteria is listed in the FOA.

Key Dates
CMS will accept three rounds of applications. Applications will be due to CMS on:
        •     August 5, 2013 (1st round);
        •     October 8, 2013 (2nd round); and
        •     January 14, 2014 (3rd round).

CMS anticipates issuing the first notice of award in September, 2013. The period of performance for each grant will run for three years beginning with the date of award.  

More Information
To view the FOA, visit:

For more information on the Financial Alignment Demonstration, visit: