Award Criteria

Advancing Medicare & Medicaid Integration awardees will be selected based on the following criteria, with more weight given to those criteria focused on meaningful transformation in care delivery, addressing issues of health equity, and states’ commitments to advance integrated care. Projects are most likely to be successful if they address the following:

  • Demonstrates meaningful transformation in care delivery for dual-eligible populations. Does the project set goals and outcomes that will address at least one of the Advancing Medicare & Medicaid Integration initiative objectives? These include: (1) increasing integration between Medicare and Medicaid through existing or new models; (2) increasing enrollment in integrated coverage options; and (3) ensuring that dual-eligible individuals receive services that lead to better patient experiences, higher quality of care, and reduced health care costs.
  • Uses appropriate methods to achieve stated objectives. Do the proposed activities align with the project types that initiative will support?
  • Indicates sufficient organization capacity and state commitment. Does the applicant clearly identify its capacity to carry out the proposed project? Does the project application indicate commitment from all necessary state stakeholders, including agency leadership and legislative leadership (as applicable)? Does the applicant demonstrate an understanding of the state’s internal process requirements (including timing) for review, approval, execution, and implementation of a funding agreement?
  • Engages stakeholders. Does the project solicit input from various stakeholders, including beneficiaries and providers?
  • Addresses issues of health equity. Does the project take health equity and racial and ethnic disparities into consideration? Does the project consider equity in its definition of Medicare-Medicaid integration?
  • Considers potential project challenges. Does the application address anticipated challenges to conducting the work and consider strategies to address those challenges?
  • Includes programmatic and financial sustainability planning. Does the project include plans for sustaining project accomplishments after the funding period ends?
  • Budgets appropriately to accomplish project activities. Is the project budget appropriate to the scale of the activities proposed? Will state applicants be able to request federal matching funds for any qualified Medicaid program expenditures? If so, does the state applicant demonstrate an understanding of the internal state process requirements (including timing) to request matching funds?

Related Webinar

This webinar provided an overview of the initiative, its goals for improving care delivery for dual-eligible individuals, and the initiative application process.


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