Using authority in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) has launched demonstrations that seek to improve care and control costs for people who are dually eligible for Medicare and Medicaid. Nearly 355,000 beneficiaries in nine states are enrolled in these demonstrations as of June, 2015. Implemented beginning in July 2013, the demonstrations are changing the care delivery systems through which beneficiaries receive medical and long-term care services and the financing arrangements among CMS, the states, and providers. The demonstrations initially were approved for three years, but in July, 2015, CMS announced that states may extend their demonstrations for an additional two years. As of July 2015, CMS has finalized memoranda of understanding (MOUs) with 13 states to implement demonstrations: (1) Ten states (California, Illinois, Massachusetts, Michigan, New York, Ohio, South Carolina, Rhode Island, Texas, and Virginia) are testing a capitated financial alignment model; (2) Two states (Colorado and Washington) are testing a managed fee-for-service (FFS) financial alignment model; and (3) One state (Minnesota) is testing the integration of administrative functions without financial alignment (Figure 1). The status of past proposals from other states is detailed in the Appendix. This issue brief compares key provisions of the approved demonstrations, summarized in Table 1 on the next page.
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