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

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.

Eligible applicants from the CMS-approved Financial Alignment States include any one of the State agencies that administers the ADRC and/or SHIP programs(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).

State Medicaid Agencies and the Medicaid Agencies in the Federal Territories - This cooperative agreement only serves beneficiaries that are dually eligible for Medicare and Medicaid coverage.

Yes. In order to apply, applicants must include a copy of the signed MOU with CMS to implement an approved Financial Alignment model.

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 Individuals (dual eligibles) to ensure that these individuals have access to an unbiased and consumer friendly source of information and counseling - distinct from the Demonstration Plans and Enrollment Brokers - to help them make informed decisions about options they have for receiving their Medicare and Medicaid benefits.

This Cooperative Agreement is being funded for a period of performance of three (3) years, with support beyond the first year contingent upon acceptable evidence of satisfactory progress, and continuing program relevance.

The standard application form SF-424 and related forms must be used for this program. In addition to the standard forms, applicants must provide a copy of the signed MOU with CMS to implement an approved Financial Alignment model. Applicants should review the application and submission information in the funding opportunity announcement for specific instructions on applying for this cooperative agreement program.

Applicant should refer to the funding opportunity announcement under this CFDA program for specific criteria requirements on proposal selection

Successful applicants will receive a Notice of Award (NoA) signed and dated by the Grants Management Officer.