1. The Medicare-Medicaid Financial Alignment Initiative Overview and Status Update
Lindsay Barnette
Medicare-Medicaid Coordination Office
Centers for Medicare & Medicaid Services
November 3, 2016

2. Medicare-Medicaid Enrollee Delivery System Transformation
Current State
Future State
Provider and Payor-Centered
Person-Centered
Fragmented Care
Coordinated Care
Volume-Driven
Outcome-Driven
Complicated Benefit Overlap
Simplified Processes 2

3. About the Medicare-Medicaid Coordination Office3

4. Medicare-Medicaid Coordination Office
Section 2602 of the Affordable Care Act
Purpose: Improve quality, reduce costs, and improve the experience for individuals who receive Medicare and Medicaid benefits.
Ensure full access to services to which they are entitled
Improve coordination between the federal government and states
Develop innovative care coordination and integration models
Eliminate financial misalignments that lead to poor quality and cost shifting 4

5. Medicare-Medicaid Coordination Office
Vision: Promote an improved experience for persons with both Medicare and Medicaid by:
Focusing on person-centered models that promote coordination
Developing a more easily navigable and simplified system of services
Ensuring individual access to needed services and incorporating individual protections into each aspect of the new demonstrations
Establishing accountability for outcomes across Medicare and Medicaid
Requiring robust network adequacy standards for both Medicare and Medicaid
Evaluating data on access, outcomes, and individual experience to ensure individuals receive higher quality, more cost-effective care 5

6. Overview of the Financial Alignment Initiative (FAI)6

7. Financial Alignment Initiative
Background:
A longstanding barrier to coordinating care for Medicare-Medicaid enrollees is the financial misalignment between Medicare and Medicaid
In 2011, CMS announced new models to integrate the service delivery and financing of both Medicare and Medicaid through federal-state demonstrations to better serve the population
Goal:
Increase access to quality, seamlessly integrated services for Medicare- Medicaid enrollees 7

8. Financial Alignment Initiative
FAI Demonstration Models:
Capitated Model: Three-way contracts among states, CMS, and health plans to provide comprehensive, coordinated care in a more cost- effective way
Managed Fee-for-Service (FFS) Model: Agreements between states and CMS under which states would be eligible to benefit from savings resulting from initiatives to reduce costs in both Medicaid and Medicare
Alternative Model:
Agreement to integrate care for Medicare-Medicaid enrollees building on the State’s current infrastructure (MN) 8

9. The Capitated Model Enrollment assistance and options counseling
Integrated set of enrollee materials and single ID card
Person-centered care planning
Choice of plans and providers
Minimum travel and distance times
Limitations on wait and appointment times
Continuity of care provisions
Care coordination and assistance with care transitions
Integrated grievances and appeals process
Substantive participating provider training requirements 9

10. Current Status of the FAI10

11. FAI Participating StatesWA OR WY UT TX SD OK ND NM NV NE MT LA KS ID HI CO CA AR AZ AK WI WV VA TN SC OH NC MO MS MN MI KY IA IN IL GA FL AL VT PA
NY* NJ NH MA ME CT DE RI MD DC
Capitated financial alignment demonstration (10 states)
Administrative alignment demonstration (1 state)
Managed FFS financial alignment demonstration (2 states)
*CMS and NY operate two separate capitated demonstrations, both in the NYC area. 11

12. FAI Participating States
Demonstration Name
Start Date
Washington*
HealthPathWashington
July 2013
Massachusetts
One Care
October 2013
Illinois
Medicare-Medicaid Alignment Initiative
March 2014
California
Cal MediConnect
April 2014
Virginia
Commonwealth Coordinated Care
Ohio
MyCare Ohio
May 2014
Colorado*
Accountable Care Collaborative
September 2014
New York
Fully Integrated Duals Advantage (FIDA)
January 2015
South Carolina
Healthy Connections Prime
February 2015
Michigan
MI Health Link
March 2015
Texas
Texas Dual Eligible Integrated Care Project
FIDA Intellectual and Developmental Disabilities (IDD)
April 2016
Rhode Island
Rhode Island Integrated Care Initiative
July 2016
*WA and CO are operating Managed FFS model demonstrations. All other states are operating Capitated model demonstrations. 12

13. FAI Independent Evaluation
CMS contracted with RTI International to evaluate the demonstrations under the Financial Alignment Initiative
The mixed methods evaluation includes qualitative components (e.g. site visits, beneficiary focus groups) and quantitative components (e.g. analyses on measures of quality, utilization, access to care, and costs)
The first annual evaluation reports for Washington and Massachusetts were recently released
An issue brief with early implementation findings from the first seven demonstrations is also available 13

14. FAI Lessons Learned Positive momentum
Dramatic increase in the number of Medicare-Medicaid beneficiaries in financially integrated or total cost-of-care models
Hundreds of thousands of assessments, increasing every day
Major investments in new care coordination infrastructure
Lessons learned
Communications and enrollment
Provider outreach and engagement
Earning beneficiary engagement
Unmet need
Success stories 14

15. More Information
Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/ 15