States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model | CMS 4S4 24 001

Opportunity Information: Apply for CMS 4S4 24 001

The States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model is a Centers for Medicare and Medicaid Services (CMS) funding opportunity that invites states and territories to apply for a voluntary, state-based payment and service delivery model aimed at slowing health care cost growth, improving overall population health, and advancing health equity by reducing disparities in outcomes. The program is structured as a cooperative agreement, meaning CMS expects an ongoing partnership with selected awardees as they plan, implement, and operate the model. The opportunity is listed as a discretionary program under the Affordable Care Act (CFDA 93.968) and is identified by Funding Opportunity Number CMS-4S4-24-001.

At its core, AHEAD is designed to test a flexible statewide or sub-state framework where states take responsibility for meeting accountability targets related to (1) all-payer and Medicare fee-for-service (FFS) cost growth, (2) investment in primary care, and (3) equity and population health outcomes. Rather than focusing only on a single payer or a narrow slice of the system, the model is built around multi-payer alignment and broader system accountability, with the idea that cost containment and better outcomes are more achievable when Medicare FFS, Medicaid, and other payers are pulling in the same direction.

The model includes several major components intended to help participating states reach those targets. First, selected states receive an upfront investment through the cooperative agreement funding to support planning and implementation activities. Second, participating hospitals would operate under Medicare FFS and Medicaid hospital global budgets, a payment approach that sets a budgetary target for hospital revenue/spending and is intended to encourage hospitals to manage costs and shift attention toward prevention and efficient care rather than maximizing volume. Third, AHEAD includes a primary care program for participating primary care practices, reflecting the model emphasis on increasing and sustaining primary care investment as a lever for better outcomes and reduced avoidable utilization.

AHEAD runs for 11 years in total, spanning 2024 through 2034, with all cohorts ending on December 31, 2034. States must apply into one of three cohorts depending on how ready they are to implement the model, which allows CMS to accommodate different starting points and capacities across applicants. CMS plans to select up to eight award recipients through a competitive process. Each selected awardee can receive up to $12 million in cooperative agreement funding, distributed over a period of up to six years, to support the work required to launch and operationalize the model.

Eligibility is limited to state governments and qualifying U.S. territories, specifically state agencies such as State Medicaid Agencies (SMAs), state public health agencies, state insurance agencies, or other state entities that have relevant rate-setting or budget authority and can legally accept and administer the cooperative agreement funds. States are allowed to submit a joint application involving multiple state agencies, but CMS requires that only one agency serve as the official award recipient and accept the funds. If the State Medicaid Agency is not the designated recipient agency, it must still be included as a subrecipient, underscoring Medicaid's central role in the model structure and hospital/primary care payment changes.

Geographic eligibility includes all 50 states, Washington, D.C., and the U.S. territories of American Samoa, Guam, the Northern Mariana Islands, the U.S. Virgin Islands, and Puerto Rico, as long as the proposed state or sub-state region includes at least 10,000 resident Medicare FFS beneficiaries enrolled in Parts A and B, based on CMS Medicare Monthly Enrollment data. Applicants may propose participation either statewide or within a specific sub-state region, but sub-state participation is subject to CMS approval during application review. If a state starts with a sub-state region, there may be an option to expand that region during the pre-implementation period, but any expansion requires CMS approval and is not guaranteed.

There are also important program interaction limits tied to the Making Care Primary (MCP) Model. If MCP is operating statewide in a state, that state cannot participate in AHEAD. If MCP is only operating in a sub-state region, the state may still apply for AHEAD, but only in a different sub-state region with no geographic overlap. This restriction is meant to prevent duplicative model participation and conflicting incentives in the same geography.

Key administrative details from the notice include an original application closing date of August 12, 2024, an award ceiling of $12,000,000 per recipient, and an expectation of up to eight total awards. The sponsoring agency is CMS, and the opportunity was created on November 16, 2023. Overall, AHEAD is positioned as a long-term, system-level transformation effort that combines upfront implementation funding with payment reform tools (global hospital budgets and primary care supports) and formal accountability targets to drive cost control, improve health outcomes, and measurably reduce inequities.

• The Centers for Medicare Medicaid Services in the affordable care act sector is offering a public funding opportunity titled "States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.968.
• This funding opportunity was created on 2023-11-16.
• Applicants must submit their applications by 2024-08-12. (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 $12,000,000.00 in funding.
• The number of recipients for this funding is limited to 8 candidate(s).
• Eligible applicants include: State governments.

Apply for CMS 4S4 24 001

[Watch] Creating a grant proposal using the step-by-step wizard inside the applicant portal: