CMS Grant: Support for Ombudsman and Beneficiary Counseling Programs for Dually Eligible Individuals

The Centers for Medicare & Medicaid Services (CMS) is partnering with states to test models that integrate care and financing for individuals who are dually eligible to receive services through both Medicare and Medicaid (referred to in this funding opportunity as beneficiaries). Demonstrations testing these financial alignment models are currently in operation in ten states, serving hundreds of thousands of beneficiaries. At the time of the initial posting of this Notice of Funding Opportunity (NOFO), CMS is engaged in discussions with states regarding the future of these demonstrations. Through this NOFO, CMS is making available resources to states and entities designated by states to support and assist beneficiaries eligible for ongoing financial alignment model demonstrations. CMS has previously provided similar support to financial alignment model demonstration states for ombudsman and one-on-one counseling programs, most recently through a NOFO issued in 2016, “Support for Ombudsman and Beneficiary Counseling Programs for States Participating in the Medicare-Medicaid Financial Alignment Initiative.” This NOFO offers two types of activities to support beneficiary decision-making and empowerment: 1) ombudsman services; and 2) one-on-one counseling. It is open only to states that are currently receiving funding to conduct these activities as part of a financial alignment model demonstration, and to entities designated by these states. States will only receive funding for a particular activity (i.e. ombudsman services or one-on-one counseling) if they have received funding for that activity under the prior NOFO (Funding Opportunity Number # CMS-1J1-17-001). In addition, to be eligible for funding under this NOFO, applying states must have a financial alignment model demonstration or a comparable model test using authority under Section 1115A of the Social Security Act that will operate beyond the end of the award under the prior NOFO.

Through this NOFO, CMS is making available resources to states and entities designated by states to support and assist beneficiaries eligible for ongoing financial alignment model demonstrations. CMS has previously provided similar support to financial alignment model demonstration states for ombudsman and one-on-one counseling programs, most recently through a NOFO issued in 2016, “Support for Ombudsman and Beneficiary Counseling Programs for States Participating in the Medicare-Medicaid Financial Alignment Initiative.”
This NOFO offers two types of activities to support beneficiary decision-making and empowerment: 1) ombudsman services; and 2) one-on-one counseling. It is open only to states that are currently receiving funding to conduct these activities as part of a financial alignment model demonstration, and to entities designated by these states. States will only receive funding for a particular activity (i.e. ombudsman services or one-on-one counseling) if they have received funding for that activity under the prior NOFO (Funding Opportunity Number # CMS-1J1-17-001). In addition, to be eligible for funding under this NOFO, applying states must have a financial alignment model demonstration or a comparable model test using authority under Section 1115A of the Social Security Act that will operate beyond the end of the award under the prior NOFO.