Opportunity Information: Apply for CMS 1J1 13 001
Apply for CMS 1J1 13 001
- The Centers for Medicare Medicaid Services in the health sector is offering a public funding opportunity titled "Support for Demonstration Ombudsman Programs Serving Beneficiaries of Financial Alignment Models for Medicare Medicaid Enrollees" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.634 ACA Support for Demonstration Ombudsman Programs Serving Beneficiaries of State Demonstrations to Integrate Care for Med.
- This funding opportunity was created on Jan 14, 2015 and posted on Jun 28, 2013.
- Applicants must submit their applications by Mar 17, 2015 This announcement has been modified to extend the application due date to March 17, 2015.. (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 $125,000.00 in funding.
- The number of recipients for this funding is limited to 2 candidate(s).
- Eligible applicants include: State governments.
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Opportunity Summary:
The grant opportunity titled "Support for Demonstration Ombudsman Programs Serving Beneficiaries of Financial Alignment Models for Medicare Medicaid Enrollees" is a Centers for Medicare and Medicaid Services (CMS) discretionary funding announcement designed to help states build and operate Ombudsman Programs tied to the Financial Alignment model. The core aim is to fund, over a three-year period, the planning, development, and delivery of ombudsman services for individuals participating in these demonstrations, which are intended to better integrate care for people enrolled in both Medicare and Medicaid. The program emphasizes practical, person-centered help so beneficiaries have a trusted, independent place to go when they face problems connected to the demonstration or the health plans involved.
A central function of the funded Ombudsman Program is direct beneficiary assistance. That means helping people understand their options and rights within the Financial Alignment demonstration, navigate plan-related issues, and resolve complaints or disputes that may come up during enrollment, service delivery, or care coordination. The opportunity highlights "person centered assistance," which signals that the service model should be responsive to individual needs and circumstances rather than a one-size-fits-all help line. In practice, this kind of ombudsman support often includes explaining benefits, assisting with appeals or grievances, addressing access-to-care barriers, and troubleshooting issues where Medicare and Medicaid coverage rules intersect.
Beyond individual casework, the Ombudsman Program is also intended to be a structured feedback mechanism for improving the demonstrations themselves. The announcement makes clear that ombudsman activities should generate insights for states, participating health plans, CMS, and other stakeholders about what beneficiaries are experiencing. The program is expected to identify patterns in complaints, gaps in services, or recurring administrative obstacles, then translate those findings into recommendations for improvement in a state's Financial Alignment initiatives. In other words, the ombudsman is not just a helper for individual beneficiaries; it is also a learning and quality-improvement channel that can inform policy and operational changes.
Administratively, this opportunity is offered as a cooperative agreement, which typically means CMS expects a more active role in overseeing or collaborating on the funded work than under a standard grant. The funding activity category is health, and the associated CFDA number is 93.634. CMS anticipated making two awards under this announcement. The ceiling amount listed is $125,000, with no stated award floor, and there is no cost-sharing or matching requirement, meaning states would not be required to contribute a set percentage of non-federal funds to receive the award.
Eligibility is limited to state governments, reflecting the fact that Financial Alignment demonstrations are state-based initiatives that coordinate Medicare and Medicaid for dually eligible individuals. The original posting date was June 28, 2013, with an original closing date of August 5, 2013 (3:00 PM EST). The announcement was later modified to extend the application due date to March 17, 2015, and it was archived on April 16, 2015. For application access issues, the listed support channel is the Grants.gov Contact Center (1-800-518-4726, support@grants.gov), which operates 24/7 except federal holidays.
Taken together, the opportunity funds states to establish or strengthen an ombudsman capability specifically tailored to beneficiaries enrolled in Financial Alignment model demonstrations, with an emphasis on resolving real-world beneficiary problems and systematically feeding beneficiary experience back into state and federal efforts to improve integrated care for Medicare-Medicaid enrollees.
Frequently Asked Questions (FAQs)
What is the title of this grant opportunity?
The opportunity is titled "Support for Demonstration Ombudsman Programs Serving Beneficiaries of Financial Alignment Models for Medicare Medicaid Enrollees."
Which federal agency is offering this funding?
This is a Centers for Medicare and Medicaid Services (CMS) discretionary funding announcement.
What is the main purpose of the grant?
The core purpose is to help states build and operate Ombudsman Programs connected to Financial Alignment model demonstrations. These programs are meant to provide practical, person-centered help to beneficiaries enrolled in demonstrations that integrate Medicare and Medicaid services.
What does the grant fund over the project period?
The grant is intended to fund, over a three-year period, the planning, development, and delivery of ombudsman services for individuals participating in Financial Alignment model demonstrations.
What is an Ombudsman Program in the context of this opportunity?
In this context, an Ombudsman Program is an independent, trusted place for beneficiaries to go when they experience problems tied to the Financial Alignment demonstration or the health plans involved. A central function is direct beneficiary assistance, including help understanding rights and options, navigating plan issues, and resolving complaints or disputes.
Who is intended to be served by the funded Ombudsman Program?
The program is designed to serve beneficiaries participating in Financial Alignment model demonstrations, which focus on people enrolled in both Medicare and Medicaid (often referred to as Medicare-Medicaid enrollees).
What kinds of help are considered "direct beneficiary assistance" under this grant?
Direct beneficiary assistance includes helping individuals understand their options and rights within the demonstration, navigate plan-related issues, and address complaints or disputes that arise during enrollment, service delivery, or care coordination.
What does "person-centered assistance" mean in this announcement?
"Person-centered assistance" signals that support should be responsive to each beneficiary's individual needs and circumstances, rather than operating as a one-size-fits-all help line.
What types of issues might the Ombudsman Program help with?
The announcement describes help such as explaining benefits, assisting with appeals or grievances, addressing access-to-care barriers, and troubleshooting issues where Medicare and Medicaid coverage rules intersect, particularly as those issues relate to the demonstration or participating health plans.
Is the Ombudsman Program only about helping individual beneficiaries?
No. Beyond individual casework, the Ombudsman Program is also intended to function as a structured feedback mechanism to improve the demonstrations. Ombudsman activities are expected to identify patterns in complaints and recurring issues, then translate those findings into recommendations for states, participating health plans, CMS, and other stakeholders.
What does CMS expect the Ombudsman Program to report or communicate back to stakeholders?
The announcement indicates the program should generate insights about beneficiary experiences, including patterns in complaints, service gaps, and recurring administrative obstacles, and provide recommendations that can inform improvements to a state's Financial Alignment initiatives.
What type of award instrument is this?
This opportunity is offered as a cooperative agreement, which typically means CMS expects a more active role in overseeing or collaborating on the funded work than under a standard grant.
What is the funding activity category?
The funding activity category is health.
What CFDA number is associated with this funding announcement?
The associated CFDA number is 93.634.
How many awards did CMS anticipate making?
CMS anticipated making two awards under this announcement.
What is the maximum (ceiling) award amount?
The ceiling amount listed is $125,000.
Is there a minimum (floor) award amount?
No award floor is stated in the provided announcement information.
Is cost sharing or matching required?
No. The announcement states there is no cost-sharing or matching requirement, meaning states are not required to contribute a set percentage of non-federal funds to receive the award.
Who is eligible to apply for this grant?
Eligibility is limited to state governments, reflecting that Financial Alignment demonstrations are state-based initiatives that coordinate Medicare and Medicaid for dually eligible individuals.
When was the opportunity originally posted?
The original posting date was June 28, 2013.
What was the original application closing date and time?
The original closing date was August 5, 2013, with a listed deadline time of 3:00 PM EST.
Was the due date ever extended?
Yes. The announcement was later modified to extend the application due date to March 17, 2015.
When was the opportunity archived?
The opportunity was archived on April 16, 2015.
Where can applicants get help if they have trouble accessing the application?
For application access issues, the announcement lists the Grants.gov Contact Center: 1-800-518-4726 and support@grants.gov. It operates 24/7 except federal holidays.
What is the Financial Alignment model referenced in the announcement?
The announcement describes Financial Alignment demonstrations as state-based initiatives intended to better integrate care for people enrolled in both Medicare and Medicaid.
What is the practical outcome CMS appears to be seeking through this funding?
Based on the announcement, CMS aims to ensure beneficiaries in Financial Alignment demonstrations have a trusted, independent place to turn for resolving real-world problems, while also creating a consistent channel for capturing beneficiary experience and using it to improve integrated care operations and policy.
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