The Center for Medicare & Medicaid Innovation conducts and sponsors numerous innovative demonstration projects and model tests to measure the effect of potential program changes. CMMI demonstrations and model tests study the likely impact of new methods of service delivery, coverage of new types of service, and new payment approaches on beneficiaries, providers, health plans, states, and the Medicare Trust Funds. Evaluation projects validate our research and demonstration/model findings and help us monitor the effectiveness of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Click here for more info.
A Medicare Advantage MMP is a private health plan that provides coordinated Medicare and Medicaid benefits for dually eligible individuals. MMPs simplify the processes for dual eligible individuals to access the care they are entitled to under Medicare and Medicaid programs. This includes providing beneficiaries with a seamless enrollment and disenrollment process and access to high-quality integrated healthcare.
The Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative is testing models to better integrate primary, acute, behavioral health, and long-term services and supports, providing participating states to share in savings.
Fifteen states were initially awarded demonstration contracts, and implementation began in 2013.
The two models include (1) a prospective blended rate model for select health plans to provide both Medicare and Medicaid benefits to duals called the “capitated model”, and (2) a model that allows the state to take responsibility for coordinating the beneficiary’s care, called a “managed fee-for-service model (MFFS)”.
For more information about MMPs, D-SNPs and Medicare-Medicaid Integration click on the links below:
As of January 2020, 9 states are participating in the capitated model (CA, IL, MA, MI, MN, OH, RI, SC, TX) with total enrollment of 385,959 (January 2020).
States participating in the capitated model demonstrations are required to follow National MMP Enrollment Guidance & Exhibits. Each state has specific guidelines that contain a detailed description of the requirements for enrolling.
The SNP Alliance is pleased to provide current and archived information about SNP and MMP contracts, SNP types, locations, and enrollment compiled each month by the CMS Health Plan Management System. The information is also available on the CMS website.