On April 24, 2019, CMS released a letter to state Medicaid directors describing three opportunities for states to improve care integration for Medicaid and Medicare dually eligible beneficiaries: 1) increased flexibility under the Medicaid Financial Alignment Initiative’s capitated financial alignment model; 2) participation in the Medicaid Financial Alignment Initiative using a managed fee-for-service approach, with retrospective shared savings; and 3) adoption of a state-specific model. CMS stressed the complexity of treating dual eligibles and the need to improve care for this population to “achieve greater value.”