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Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS’s capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people who are eligible for both federal health programs. Massachusetts’ demonstration is unique among the state proposals for its focus on full dual eligible beneficiaries ages 21 to 64 and its required Independent Living-Long Term Services and Support (LTSS) Coordinators from community-based organizations independent of the demonstration health plans. This policy brief summarizes the MOU terms in the several key areas, including enrollment, care delivery model, benefits, financing, beneficiary protections and monitoring and evaluation.

Brief (.pdf)