CMS Healthy Adult Opportunity Demonstration Initiative

CMS Healthy Adult Opportunity Demonstration Initiative

CMS has announced the Healthy Adult Opportunity (HAO).  This is a new way for CMS to fund a non-LTSS portion of state’s Medicaid programs.  Currently, CMS pays states based on some matching percentage determined based on each state’s per capita federal poverty level.   In Washington state for every one dollar our state spends on federally approved programs and services, the federal government matches that expenditure. Under HAO, CMS would send the state a set total dollar amount (also known as a block grant) and the state would then need to manage their Medicaid program spending based on this fixed federal dollar amount.  This is an optional program that states would need to apply for.

HAO applies only to adults under age 65 who are not eligible for Medicaid on the basis of disability or their need for long term care services and supports and who are not eligible under a state plan. Other groups such as very low-income parents, children, pregnant women, elderly adults, and people eligible on the basis of a disability are not included in this proposal.

A more detailed analysis and its impacts will be coming from LeadingAge National and we will provide that to you as quickly as possible once received.

Please see the CMS announcement and find more information here –



David Carter | Director, Health Care Finance & Policy, LeadingAge Washington | P 253.964.8870