Medicaid-focused Opportunities from the Center for Medicare and Medicaid Innovation (CMMI)

The Center for Medicare and Medicaid Innovation (CMMI) will launch four new model opportunities in 2024 for state and territory Medicaid programs:

• Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
• Transforming Maternal Health (TMaH) Model
• Innovation in Behavioral Health (IBH) Model
• Cell and Gene Therapy (CGT) Access Model

Here’s a look at these new models, including available funding and the timeframe(s) for states and territories to submit applications.

Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model

The multi-payer, total cost of care model aims to control health care costs and improve population health by: 1) increasing investments in primary care, 2) instituting hospital global budgets, 3) implementing risk adjustment for health and social risk factors, and 4) limiting total health care cost growth in the state. The model will include Medicaid enrollees, fee-for-service Medicare enrollees, and at least one private payer. The models will run for 11 years (3-year pre-implementation period and 7-year implementation period).

Awardees: Up to eight states selected in two application periods. State agencies (including Medicaid) must be the primary applicant for this model.

Funding: Up to $12 million per state.

Timeframe to apply: Applications are due March 18, 2024 by 3 p.m. ET for the first two cohorts, and by Aug. 12, 2024 at 3 p.m. ET for the third cohort.

Transforming Maternal Health (TMaH) Model

The Transforming Maternal Health (TMaH) model will support state Medicaid agencies in developing a whole-person approach to pregnancy, childbirth, and postpartum care that addresses physical, mental health, and social needs. The model aims to improve outcomes and experiences for mothers and their newborns, while also reducing program costs. The model is expected to run for 10 years.

Awardees: Up to 15 Medicaid agencies.

Funding: Up to $17 million per state.

Timeframe to apply: The Notice of Funding Opportunity will be issued in Spring 2024. Applications will be due in Summer 2024.

Innovation in Behavioral Health (IBH) Model

The Innovation in Behavioral Health (IBH) model is focused on improving outcomes for Medicaid and Medicare populations with moderate to severe mental health conditions and substance use disorders. Medicaid agencies will support outpatient behavioral health providers (e.g., Community Mental Health Centers, opioid treatment programs, safety net providers) in addressing behavioral health, physical health, and health-related social needs. Practices that participate in the Medicare component can receive an enhanced payment. The model will run for eight years (1-to-3-year pre-implementation and 4-to-8-year implementation period).

Awardees: Up to eight state Medicaid agencies.

Funding: Cooperative agreement funding for planning and implementation (award amount not indicated).

Timeframe to apply: The Notice of Funding Opportunity will be issued in Spring 2024. The model will launch in Fall 2024.

Cell and Gene Therapy (CGT) Access Model

The Cell and Gene Therapy (CGT) Access Model is a CMS-led approach to developing and administering outcomes-based agreements for cell and gene therapies. It will initially focus on sickle cell disease. CMS will negotiate terms with manufacturers (e.g., pricing and outcome measures) and negotiated agreements will be the basis for contracts between the manufacturer and states. Medicaid agencies can choose whether to sign the negotiated contract. This is a multi-year, voluntary model for states and manufacturers.

Awardees: Participation is open to all Medicaid programs on a non-competitive basis (including all territories that participate in the Medicaid Drug Rebate Program). Medicaid programs can participate by submitting the forthcoming Request for Application.

Funding: States may apply for funding to support implementation through the Notice of Funding Opportunity. Applying to the Notice of Funding Opportunity is not a requirement to participate in the model (funding amount not specified).

Timeframe to apply: The Request for Application and Notice of Funding Opportunity for Medicaid programs will be issued in Summer 2024. States may begin participation between January 2025 and January 2026. CMMI encourages states to complete a Letter of Intent by April 1, 2024, but this letter is not required to participate in the model nor does submission of a letter obligate a state to participate in the model.