Affordable Care Act 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

Objectives: The goal of this Funding Opportunity is to provide funding over a three year period to states that have signed a Memorandum of Understanding (MOU) with CMS to implement a CMS-approved State Financial Alignment Initiative. In April 2011, the Medicare-Medicaid Coordination Office awarded design contracts to 15 states to implement State Demonstrations to Integrate Care for Medicare-Medicaid Individuals. Subsequently, CMS released a letter to State Medicaid Directors which discussed two models for integrating care and aligning financial incentives for Medicare and Medicaid as part of CMS’ Financial Alignment Initiative, a joint initiative of the Innovation Center and the Medicare Medicaid Coordination Office, under which States and CMS will collaborate to integrate care and financing for Medicare-Medicaid individuals. The Financial Alignment Initiative 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 individuals. As part of this effort, there is a need for strong beneficiary support education and outreach in each State that is implementing a Financial Alignment model, including options counseling for beneficiaries. Awardees will develop and implement a coordinated SHIP/ADRC strategy and action plan to provide beneficiaries who are eligible for both Medicare and Medicaid – during both the Phase 1 Activities and Ongoing Activities of the program, as described in the funding opportunity announcement - with objective information and one-on-one counseling on the nature of the state’s Financial Alignment model. Such activities will include, but are not limited to, providing information and counseling as to how and when the project will be implemented, the options these dual eligible beneficiaries will have for receiving their Medicare and Medicaid services in their state, the appeal rights they will have under the model, and what they need to do to participate in the program. The SHIP/ADRC staff assigned to this project must be able to provide this information and counseling in a way that is easy for beneficiaries to understand and is culturally and linguistically appropriate. These activities must be carried out in a SHIP/ADRC. Also, the SHIP/ADRC should possess a basic understanding of all CMS approved State Financial Alignment Initiatives.