State Demonstrations to Integrate Care and Align Financing for Dual Eligible Beneficiaries: A Review of the 26 Proposals Submitted to CMS

The Centers for Medicare and Medicaid Services (CMS) has proposed two models to align Medicare and Medicaid benefits and financing for dual eligible beneficiaries, one capitated model and one managed fee-for-service model. In the spring of 2012, 26 states submitted proposals to CMS seeking to test one or both of these models. CMS is presently reviewing the states’ proposals to determine which will be implemented.

This background paper examines the contents of the 26 states’ proposals in the areas of target population, implementation date, enrollment, financing, benefits, beneficiary protections, stakeholder engagement, and demonstration evaluation as set out in the states’ initial submissions to CMS. Negotiations between CMS and the states are ongoing and are likely to result in some changes from the states’ initial proposals.

Report (.pdf)