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New Opportunities to Test Innovative Models of Integrated Care for Dually Eligible Individuals

In an April 24 letter (SMDL #19-002​) to State Medicaid Directors, CMS indicated it is opening up the Financial Alignment Initiative (FAI) models to allow new states to test integration models for their dual eligible populations using successful approaches from states who are currently participating.​ This letter complements the State Medicaid Director letter (SMDL #18-012) ​released on December 19, 2018 highlighting 10 existing opportunities to improve care for dual eligible individuals.

The three new opportunities to test state-driven approaches to integrating care for dual eligible individuals​ include:

  1. The Medicare-Medicaid Financial Alignment Initiative
    • OPPORTUNITY #1 – Integrating care through the capitated financial alignment model
    • OPPORTUNITY #2 – Integrating care through the managed fee-for-service model
  2. New models for integration
    • OPPORTUNITY #3 – State-specific models ​

CMS is interested in concepts that:  

  • Promote empowerment and independence for dually eligible individuals; 
  • Increase access to coordinated care, encompassing both Medicare and Medicaid services;  
  • Enhance the quality of care furnished to individuals, with an emphasis on health outcomes; 
  • Reduce expenditures for the Medicare and Medicaid programs; 
  • Preserve:  
    • Access to all covered Medicare benefits; 
    • Cost-sharing protections for full-benefit dual eligible individuals; 
    • Beneficiary choice of providers.

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