Fact Sheets

Funding Opportunity Under the Affordable Care Act to Support State Health Insurance Assistance Program (SHIP) and Aging and Disability Resource Center (ADRC) Options Counseling for Medicare-Medicaid Individuals in States with Approved Financial Alignment Models

OVERVIEW

Section 1115A of the Social Security Act (added by section 3021 of the Affordable Care Act) authorizes the Center for Medicare and Medicaid Innovation (Innovation Center) to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and the Children’s Health Insurance Program while preserving or enhancing the quality of care.

The Innovation Center develops new service delivery and payment models in order to improve care, improve population health and lower costs, including for people enrolled in both Medicare and Medicaid (Medicare-Medicaid enrollees). One of these models, a joint effort of the Innovation Center and the Medicare-Medicaid Coordination Office, is the Financial Alignment Demonstration (the Demonstration).  This Demonstration is a unique Federal-state partnership to test aligning the service delivery and financing of the Medicare and Medicaid programs to better serve Medicare-Medicaid enrollees.

This Funding Opportunity Announcement is being jointly coordinated by the Centers for Medicare & Medicaid Services (CMS) and the Administration for Community Living (ACL). Funding under this Announcement is only available to states that have signed a Memorandum of Understanding with CMS to implement Medicare-Medicaid Financial Alignment Demonstrations.

This Funding Opportunity will provide financial assistance to State Health Insurance Assistance Programs (SHIPs) and/or Aging and Disability Resource Centers (ADRCs) to provide options counseling to Medicare-Medicaid enrollees.  This will ensure that beneficiaries and their families have access to an unbiased and beneficiary-friendly source of information and counseling on options available under the Financial Alignment Demonstration to help individuals make informed decisions about options they have for receiving their Medicare and Medicaid benefits.

Eligible applicants from the CMS-approved Financial Alignment Demonstration states include any one of the state agencies that administers the ADRC and/or SHIP program(s) within the state (e.g. State Unit on Aging, State Department of Insurance, a State Disability Agency, State Medicaid Agency or other state entity).   

BACKGROUND INFORMATION

The new Demonstration seeks to provide Medicare-Medicaid enrollees with a better care experience by testing a person-centered, integrated care program that provides a more easily navigable and seamless path to all Medicare and Medicaid services. 

Last July, CMS announced a new opportunity for States and CMS to better coordinate care for Medicare-Medicaid enrollees.  Under the Demonstrations, CMS will test the effectiveness of two models:

1)  Capitated Model in which a State and CMS contract with a health plan or other qualified entity that receives a prospective, blended payment to provide enrolled Medicare-Medicaid enrollees with coordinated care; and

2)  Managed Fee-for-Service Model in which a State and CMS enter into an agreement by which the State would be eligible to benefit from savings resulting from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid.  
CMS and ACL want to assure local counseling and informational resources are available for beneficiaries and/or caregivers who have questions about the options in their states.

DETAILS of the FUNDING OPPORTUNITY

The opportunity will provide funding over a three year period for counseling and information sharing to Medicare-Medicaid enrollees in states participating in the CMS-Approved Financial Alignment Model to integrate care for Medicare-Medicaid enrollees.  The signed Memorandum of Understanding to participate in this Financial Alignment Model program must accompany the FOA submission.

Regardless of which agency serves as the applicant agency, the State Unit on Aging, State Department of Insurance, State Disability Agency/Agencies and State Medicaid Agency must all be involved in the joint planning, development and implementation of the state’s options counseling efforts under this funding opportunity.

 The joint plan for SHIP and ADRC operational activities supported by this opportunity must be fully submitted from each eligible state.  The state entities shall jointly designate one "lead" agency.

The award will be in the form of a cooperative agreement. CMS will carry out the following activities for the cooperative agreement:

•  Perform the day-to-day federal responsibilities of managing a cooperative agreement initiative and will work with the awardee to ensure that the minimum requirements for the cooperative agreement are met;
•  Assist the awardee project leadership in understanding the policy concerns and/or priorities of CMS by conducting periodic briefings and by carrying out ongoing consultations;
•  Work cooperatively with the awardee to clarify the programmatic and budgetary issues to be addressed by the project.  Based on these negotiations, and the planning phase that will occur following the award, the awardee will revise the project work plan and budget detailing expectations for major activities and products during the project period;
•  Provide technical support to the awardee on the implementation of their project, including coordination with other awardees;
•  Provide consultation to the awardee in identifying emerging issues as they relate to the goals and objectives of this funding program;
•  Coordinate with other parts of CMS engaged in long-term services and supports systems redesign, and share with the awardee information about other Federally-supported projects and activities relevant to the awardees' scope of work;
•  Attend and participate in major project events of the awardee as appropriate.
•  Conduct site visits to awardees as appropriate.

KEY DATES

Funding Opportunity Announcement Release Date:  August 23, 2012
First Application Submission Date:  September 24, 2012
First Notice of Award Date:  October 19, 2012

FUNDING AND PERIOD OF PERFORMANCE

The total amount of federal funds for the initial round of awards under this funding opportunity is anticipated to be up to $5 million. It is anticipated that the initial funding awards will be made on October 19, 2012. 

The project period for each award will be for three (3) years.  The estimated project period for the initial round of awards will be from October 19, 2012 to October 18, 2015.

Following this deadline, based on available funding, applications will be accepted for review and approval from eligible states throughout fiscal year 2013, as detailed in the chart below. 

The following chart provides subsequent funding opportunities, pending the availability of funds.

Chart: FY 2013 Subsequent Funding Application Submissions and Review Schedule

More information on the funding opportunity will be available at www.grants.gov.