CMS Dual Eligible Demonstration


A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. To begin to address this issue, the Centers for Medicare & Medicaid Services (CMS) is testing models with States to better align the financing of these two programs and integrate primary, acute, behavioral health and long-term services and supports for their Medicare-Medicaid enrollees. 

For additional information regarding states that were awarded CMS demonstration grants, click here. 

Payment Model: 

Qualifying states have an option to pursue one or both of the capitated or the FFS financial alignment models. In states with approved demonstrations, CMS will test these models over the next several years.

Capitated Model: 

A State, CMS, and a health plan enter into a three-way contract, and the plan receives a prospective blended payment to provide comprehensive, coordinated care. Learn more about the Capitated Model.

Managed Fee-for-Service Model: 

A State and CMS enter into an agreement by which the state would be eligible to benefit from a portion of savings from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid. Learn more about the FFS Model. 

Improved Health: 
  • Participants who reported a positive impact on their quality of life credited the demonstration in general and specific features of the demonstration (e.g., care coordination, improved benefits) as making a positive difference in their physical and mental health and overall quality of life. 
Improved Patient/Clinician Satisfaction: 
  • Some participants indicated that the health care that they receive has become easier to navigate and less expensive, thereby improving their access to care and quality of life, as well as their satisfaction with the demonstration. 
  • Participants expressed positive experiences related to goal setting. Many were actively involved in the process and engaged with their care team and their physicians. 
Improved Access: 
  • For some participants, care coordination increased access to new or flexible services, including home-based services and supports, home modifications, and counseling. 

Last updated March 2019
Go to top