On April 26, 2019, CMS issued a letter to State Medicaid Directors (2019 Letter) inviting states to partner with CMS in one of three new opportunities to test state-driven approaches to integrating care for individuals who are dually eligible for Medicare and Medicaid. The opportunities include a capitated financial alignment model, a managed fee-for-service model and the opportunity to devise a state-specific model.
CMS’s news release on the 2019 Letter summarizes the three new opportunities as follows:
- Capitated Financial Alignment Model. Through a joint contract with CMS, states and health plans, this model option creates a way to provide the full array of Medicare and Medicaid services for enrollees for a set capitated dollar amount.
- Managed Fee-for-Service Model. This model is a partnership between CMS and the participating state and allows states to share in Medicare savings from innovations where services are covered on a fee-for-service (FFS) basis.
- State-Specific Models. CMS is open to partnering with states on testing new state-developed models to better serve dually eligible individuals and invite[s] states to come to [CMS] with ideas, concept papers, and/or proposals.
The 2019 Letter provides contact information for states interested in learning more about the new opportunities. The new opportunities are intended to complement the existing opportunities to improve care for dually eligible individuals, as described in a December 19, 2018 CMS letter to State Medicaid Directors.
