Texas

Texas Capitated Financial Alignment Model Demonstration (Texas Dual Eligible Integrated Care Demonstration Project)

SPOTLIGHT & RELEASES

Key Dates

May 23, 2014 - CMS and Texas sign MOU

November 25, 2014 - CMS, Texas, and participating plans execute three-way contract

March 1, 2015 - Scheduled start of opt-in enrollment

April 1, 2015 - Scheduled start of passive enrollment

December 31, 2015 - CMS, Texas, and participating plans execute updated three-way contract 

November 1, 2020 – CMS, Texas, and participating plans execute three-way contract amendment extending the demonstration

December 1, 2021 – CMS, Texas, and participating plans execute a three-way contract amendment

December 1, 2022 – CMS, Texas, and participating plans execute a three-way contract amendment

Texas Dual Eligible Integrated Care Demonstration Project Model

On May 23, 2014, the Centers for Medicare & Medicaid Services (CMS) announced that the State of Texas partnered with CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience. Under the demonstration, also called "Texas Dual Eligible Integrated Care Demonstration Project," Texas and CMS contracted with Medicare-Medicaid plans to coordinate the delivery of, and be accountable for, covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees. 

More Information from CMS:

• Fact Sheet
• Three-Way Contract (DOCX)
  • Summary of Contract Changes (04/01/2024) (PDF)
    • Texas Contract Amendment CY 2025 (PDF) 
      • Texas Contract Amendment CY 2025 Summary of Changes (PDF)
• MOU (PDF)
• Amendment to State Proposal (PDF)
• State Proposal (PDF)
• Preliminary Third Evaluation Report for the Texas capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (12/20/2023)
  • Findings at a Glance
• Preliminary Second Evaluation Report for the Texas capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (06/01/2022)
  • Findings at a Glance
• First Evaluation Report for the Texas capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (05/24/2019)
• Readiness Review Tool (PDF)
• Texas Evaluation Design Plan (PDF)
• Letter of Intent to Extend Scheduled End Date (PDF)
• Texas Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (PDF)
• Texas Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 2 (PDF)
• Texas Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 3 (PDF)
• Texas Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 4 (PDF)
• Texas Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 5 (PDF)
• Texas Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 6 (PDF)
• Texas Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 7 (PDF)

Information for Plans:

• All state-specific information and guidance for plans is available on the Information and Guidance for Plans page.

Information for Beneficiaries and Providers:

• Texas Dual Eligible Integrated Care Project Continuity of Care Provisions (PDF)
• Texas Health and Human Services Commission's (HHSC) Office of the Ombudsman
• Texas Dual Eligible Integrated Care Project Provider Frequently Asked Questions (FAQs) (PDF)
• Texas Dual Eligible Integrated Care Project Home Health Provider FAQs (PDF)

Information from the State of Texas:

• Texas Dual Eligible Integrated Care Project

Funding Support:

• Beneficiary Counseling & Ombudsman Programs

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