The Financial Alignment Initiative is designed to provide individuals dually enrolled for Medicare and Medicaid with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs. Through the Initiative, CMS partners with states to test two new models for their effectiveness in accomplishing these goals. This initiative is possible through the collaboration of the CMS Innovation Center and the CMS Medicare-Medicaid Coordination Office.
Today there are over 12 million Americans enrolled in both the Medicare and Medicaid programs. The Financial Alignment Initiative seeks to increase access to high quality, seamless systems of care that better coordinate benefits and services for the dually eligible enrollee population.
In 2011 CMS announced two new models to support care coordination for the dually eligible individuals through the Financial Alignment Initiative. Through this initiative, CMS is working with States to test two models to integrate primary, acute, behavioral health and long-term services and supports for dually eligible individuals and better align the financing of the Medicare and Medicaid programs.
The two models are:
- 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 Model: 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.
CMs is also partnering with Minnesota to implement an alternative model testing Medicare and Medicaid administrative alignment activities, building on the longstanding Minnesota Senior Health Options program.
When CMS has approved a state proposal for a demonstration under the Financial Alignment Initiative, CMS and a State develop a Memorandum of Understanding (MOU) to establish the parameters of the demonstration prior to implementation. States with an MOU are listed below:
- Colorado (ended December 31, 2017)
- New York
- Rhode Island
- South Carolina
- Virginia (ended December 31, 2017)
- California First Evaluation Report (PDF)
- Illinois First Evaluation Report (PDF)
- Massachusetts First Annual Report (PDF) | Appendices (PDF)
- Massachusetts Second Annual Report (PDF) (May 2019)
- Massachusetts Third Annual Report (PDF) (May 2019)
- Minnesota First Annual Report (PDF)
- Minnesota Second Evaluation Report (PDF)
- Ohio First Evaluation Report (PDF)
- Texas First Evaluation Report (PDF) (May 2019)
- Washington Preliminary Annual Report (PDF)
- Washington First Annual Report (PDF) | Appendices (PDF)
- Washington Second Evaluation Report (PDF)
- Early Implementation Report (PDF)
- Beneficiary Alignment Guidance document for Medicare Fee For Service Models (PDF)
- Evaluation Design Reports
- Care Coordination Issue Brief (PDF)
- Special Populations Issue Brief (PDF)
- Focus Groups Issue Brief (PDF)
- Colorado Preliminary Year 1 Savings Report (PDF)
- Colorado Preliminary Year 2 Savings Report (PDF) (May 2019)
- Washington Final Year 1 and Preliminary Year 2 Savings Report (PDF)
- Washington Final Year 2 and Preliminary Year 3 Savings Report (PDF) | Blog