Opportunity Information: Apply for CMS 1J1 19 001
The grant opportunity titled "Support for Ombudsman and Beneficiary Counseling Programs for States Participating in Financial Alignment Model Demonstrations for Dually Eligible Individuals" is a discretionary funding program offered by the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS). It is designed to strengthen consumer support systems for people who are dually eligible for Medicare and Medicaid and who are enrolled, or eligible to enroll, in state demonstrations that try to better integrate care delivery and financing across both programs. These demonstrations are part of CMS efforts to test "financial alignment" approaches that coordinate services, simplify the beneficiary experience, and improve outcomes for a population that often has complex medical, behavioral health, and long-term services and supports needs.
At its core, the funding is meant to make sure beneficiaries have reliable, independent help when navigating integrated Medicare-Medicaid models. CMS notes that financial alignment model demonstrations were operating in ten states at the time of posting and served hundreds of thousands of beneficiaries, and it also signals that discussions were underway about the future direction of these demonstrations. Against that backdrop, this Notice of Funding Opportunity (NOFO) provides resources to states (and state-designated entities) so they can continue offering hands-on assistance that supports beneficiary understanding, decision-making, and self-advocacy within these integrated programs.
The NOFO focuses on two specific types of beneficiary support activities. The first is ombudsman services, which generally means an independent, beneficiary-facing function that helps people understand their rights and options, resolve problems with plans or providers, and navigate complaints and appeals processes. The second is one-on-one counseling, which is more individualized guidance to help beneficiaries make informed choices and handle practical issues that come up while receiving services under the demonstration. CMS frames both activities as tools to promote beneficiary empowerment and protect beneficiaries as states test and operate integrated models.
Eligibility is intentionally narrow and tied to prior participation. Only state governments are eligible applicants, and the opportunity is open only to states that are already receiving funding to conduct these ombudsman and/or one-on-one counseling activities as part of a financial alignment model demonstration, along with entities designated by those states. In addition, a state can only receive funding for a particular activity if it previously received funding for that same activity under the earlier NOFO identified as CMS-1J1-17-001. This makes the program more of a continuation or sustainment mechanism rather than a new entry point for states that have never operated these beneficiary support functions through CMS financial alignment demonstration funding.
A further requirement is that the applying state must have a financial alignment model demonstration, or a comparable model test, operating under Section 1115A of the Social Security Act, and that this model must continue beyond the end of the prior award period. In practical terms, CMS is ensuring the grant dollars support beneficiary assistance infrastructure in places where the underlying integrated-care demonstration will still be active, rather than funding programs that would outlast the demonstration itself.
From an administrative standpoint, the funding instrument is a cooperative agreement, which typically indicates substantial federal involvement compared to a standard grant. The opportunity is categorized under Health and carries CFDA number 93.634. The opportunity number is CMS-1J1-19-001, with a creation date of April 1, 2019 and an original application closing date of May 30, 2019. CMS anticipated making 12 awards, with an award ceiling listed at $5,600,000. Overall, the NOFO is best understood as CMS support to maintain and reinforce consumer protection and beneficiary navigation services for ongoing Medicare-Medicaid integration demonstrations, specifically by continuing established ombudsman and individualized counseling capacities in participating states.Apply for CMS 1J1 19 001
- The Department of Health and Human Services, Centers for Medicare Medicaid Services in the health sector is offering a public funding opportunity titled "Support for Ombudsman and Beneficiary Counseling Programs for States Participating in Financial Alignment Model Demonstrations for Dually Eligible Individuals" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.634.
- This funding opportunity was created on Apr 01, 2019.
- Applicants must submit their applications by May 30, 2019 No Explanation. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
- Each selected applicant is eligible to receive up to $5,600,000.00 in funding.
- The number of recipients for this funding is limited to 12 candidate(s).
- Eligible applicants include: State governments.
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