Financial Alignment Initiative for Beneficiaries Dually Eligible for Medicaid and Medicare

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January 2018 | Dually Eligible Beneficiaries, Medicaid and Other Payers

Medicaid and Medicare together provide health coverage for approximately 10.8 million low-income seniors and people with disabilities who are dually eligible for both programs. The Centers for Medicare & Medicaid Services’ Medicare-Medicaid Coordination Office has implemented the Financial Alignment Initiative to improve care and reduce program costs for these beneficiaries, as well as improve coordination between the Medicaid and Medicare programs.

As of December 2017, 13 states participated in the Financial Alignment Initiative either under a capitated model, a managed fee-for-service model, or an alternative model, with approximately 404,000 individuals enrolled. Demonstrations in two states ended in December 2017, and 11 states continued their demonstrations into 2018. This issue brief describes the overall design of the initiative, and compares key provisions of the approaches in the capitated model demonstrations in 11 states. It provides updated information on enrollment, plan, and state participation in the demonstration, and changes in payment methodologies. A brief summary of each capitated model is available at the links below.

Publication Type: Issue Briefs

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Tags: access, Affordable Care Act, benefits, capitation, dually eligible beneficiaries, duals demonstrations, eligibility, enrollment, fee for service, Medicaid, Medicare, people with disabilities, rate setting