Integrated Care Activities

  • Financial Alignment Demonstration: Capitated model
    (Demo ended 12/31/17)
    Dual Eligible Special Needs Plan Contracting: Yes
    Medicaid Managed Long-Term Services: Yes
    Approved Medicaid Health Home: No
    Program of All-Inclusive Care for the Elderly (PACE): Yes

Related Resources

  • Other Resource

    State and County Data File, 2012

    The most recent demographic, enrollment, and expenditure data for dually eligible beneficiaries is in the zip file "State and County Data File 2012" found on the Medicare-Medicaid Coordination Office website. Additional data and statistical resources for the years 2007, 2008, 2009, and 2011 can be found in the Medicare-Medicaid Enrollee State Profiles. See also Defining Medicare-Medicaid Enrollees in CMS Data Sources. (Centers for Medicare & Medicaid Services)
    Topic: Data for Medicare-Medicaid Integration
  • Other Resource

    Key Demonstration Documents on the MMCO Website

    These documents, including Viginia's proposal, three-way contract, readiness review tool, and evaluation design plan, are posted on the Medicare-Medicaid Coordination Office's website. (Centers for Medicare & Medicaid Services)
  • Other Resource

    Early Insights from Commonwealth Coordinated Care: Virginia's Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    This case study describes the early implementation of Virginia's capitated financial alignment demonstration. (Kaiser Family Foundation)
  • Brief

    State Approaches to Developing and Operating Ombudsman Programs for Demonstrations under the Financial Alignment Initiative

    Ombudsman programs can offer beneficiary protections as part of Medicaid managed care programs. These programs are particularly important for beneficiaries with complex physical and behavioral health conditions, including many dually eligible individuals. For the demonstrations under the Financial Alignment Initiative, the Centers for Medicare & Medicaid (CMS) and states incorporated ombudsman programs to help to resolve enrollees’ problems and alert Medicare-Medicaid Plans (MMPs), states, and CMS of emerging trends and issues. This technical assistance brief compares approaches that states took in structuring ombudsman programs and discusses the benefits and challenges of both models. It also examines the services offered by ombudsman programs and the value these programs have brought to the demonstrations. This brief is designed to help state Medicaid agencies that are developing beneficiary support systems or implementing new integrated care programs to better understand the full range of beneficiary needs within their dually eligible populations and how ombudsman programs or similar support systems could bring value to their efforts. (Integrated Care Resource Center)
    Topic: Financial Alignment Demonstrations, Quality and Performance Measurement, Background on Long-Term Services and Supports, Assessment, Care Planning, and Care Coordination
  • Brief

    Communicating Early Results of Integrated Care Efforts for Dually Eligible Individuals: State Approaches

    This brief describes approaches that states have used to communicate early integrated care program results. Strategies discussed include developing program indicator dashboards, disseminating beneficiary experience data, and sharing success stories. (Center for Health Care Strategies)
    Topic: Capitated Model, Quality and Performance Measurement, Beneficiary Engagement, Counseling, and Support, Provider Engagement
  • Brief

    Interdisciplinary Care Teams for Medicare-Medicaid Enrollees: Considerations for States

    This brief describes key considerations for developing interdisciplinary care teams and explores how eight states addressed issues such as engaging providers and measurement approaches. (Center for Health Care Strategies)
    Topic: Assessment, Care Planning, and Care Coordination, Provider Engagement
  • Other Resource

    Report on Early Implementation of Demonstrations under the Financial Alignment Initiative

    This report describes early implementation activities occurring in the first six months of the seven financial alignment demonstrations launched as of May 1, 2014. (RTI International)
    Topic: Capitated Model, Managed Fee-for-Service Model
  • Brief

    Risk Stratification to Inform Care Management for Medicare-Medicaid Enrollees: State Strategies

    This brief describes how three states - California, Ohio, and Virginia - are requiring Medicare-Medicaid Plans to stratify Medicare-Medicaid enrollees by their level of need within capitated financial alignment demonstrations. (Center for Health Care Strategies)
    Topic: Assessment, Care Planning, and Care Coordination
  • Brief

    Three State Paths to Improve Medicaid Managed Long-Term Care: Florida, New Jersey, and Virginia

    This brief looks at the paths pursued by Florida, New Jersey, and Virginia in implementing MLTSS approaches focused on helping individuals to live in their communities rather than nursing facilities. (Center for Health Care Strategies)
    Topic: Background on Long-Term Services and Supports