Financial Alignment Initiative for Beneficiaries Dually Eligible for Medicaid and Medicare

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July 2016 | Medicaid and Other Payers

Medicaid and Medicare together provide health coverage for approximately 10 million low-income seniors and people with disabilities who are dually eligible for both programs. The Centers for Medicare & Medicaid Services’ Federal Coordinated Health Care 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 June 2016, 13 states participate in the Financial Alignment Initiative either under a capitated model, a managed fee-for-service model, or an alternative model, with approximately 450,000 individuals enrolled. This issue brief describes the overall design of the initiative, and compares key provisions of state approaches in the 11 capitated model demonstrations currently underway. It provides updated information on enrollment, plan and state participation in the demonstration, and changes in payment methodologies. A brief summary of each capitation demonstration model is available at the links below.

Publication Type: Issue Briefs

Fact Sheets

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