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Development of the Financial Alignment Demonstrations for Dual Eligible Beneficiaries: Perspectives from National and State Disability Stakeholders

As part of the implementation of the Affordable Care Act, 26 states submitted proposals to the Centers for Medicare and Medicaid Services (CMS) to implement demonstrations to integrate care and align financing for beneficiaries who are dually eligible for Medicare and Medicaid; as of July 2013, six states have received approval from CMS to implement a demonstration, and 16 proposals remain pending review.  Given the degree of interest in these demonstrations, we sought to identify common issues and potential solutions to inform other states as they develop and implement demonstrations.  With an emphasis on illuminating the specific concerns of beneficiaries under age 65 and those who use long-term services and supports, we conducted a series of 26 structured interviews with national and state disability stakeholders from October 2012 through January 2013.  Respondents included representatives of cross disability coalitions and organizations representing people with physical, mental health, and developmental disabilities, as well as legal services providers.  In addition to representatives of national organizations, we focused on examining the experience to date in Colorado, Massachusetts, Michigan, Ohio, and Washington. This issue brief provides an early snapshot into disability community perspectives on state design and implementation efforts related to the new demonstrations.