State Withdraws Proposal to CMS

State Withdraws Proposal to CMS

A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. To help solve the problem, CMS is going to test tow models to help states better align the financing for these two programs and to integrate primary, acute, behavioral health, and long term services to help Medicare-Medicaid enrollees.

To participate in Financial Alignment Demonstrations, states had to submit a proposal outlining their approach. On April 10th, Thomas Betlach, Director of Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency sent a letter to Melanie Bella, Director for the Medicare-Medicaid Coordination Office at CMS  to withdraw Arizona’s proposal to pursue the CMS demonstration for members in Medicaid and Medicare.

Betlach gives several reasons why Arizona is withdrawing their proposal:

  • Arizona is in the midst of two significant procurements for managed care plans with October 1, 2013 start dates involving complex transitions for members and services
  • Additional procurements are scheduled during the three year demonstration period
  • Significant political and operational challenges are involved with restoring coverage for childless adults and developing the infrastructure required for the ACA
  • All current health plans help dual eligible Special Needs Persons or D-SNPs
  • 43,000 members are currently aligned with contracted health plans
  • General mental health/substance abuse services are currently not integrated for some members


In addition, some of the other risks for Arizona include the start date for implementation, the path forward after the three year demonstration, and the issues surrounding capitation rates and supplemental benefits.

The state of Arizona has therefore decided to pursue alignment through the use of the state’s managed care model. The State is looking to build off the D-SNP platform and move forward. In addition, the state is going to pursue partnerships with other states and the National Association of Medicaid Directors to leverage D-SNPs and build upon the success the state has had so far.

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