Health at Home Frequently Asked Questions | ACL Administration for Community Living

Which organization in the required community-clinical partnership should be the applicant?
The applicant should be a community care hub (CCH) that represents a partnership between an advanced community care network and at least one health care organization. Multiple CCHs can collaborate on a submission, but one CCH must be designated as the Challenge team lead. This CCH must be connected to an area agency on aging, an aging and disability resource center, a center for independent living, or another aging or disability network organization.
Does the lead community care hub need to be designated as an area agency on aging, aging and disability resource center, center for independent living, or other aging or disability network organization?
The lead community care hub does not have to be a AAA, ADRC, or CIL, or other aging or disability network organization, but these entities should be engaged as part of the advanced community care network and should play a meaningful role with respect to governance, service delivery, or other operational aspects of the hub.
How is a challenge competition different from a grant?
The primary difference between a challenge competition and a grant is that a grant provides funding to a recipient to do work, while a prize competition awards a winner after the work has already been completed. Grants are usually prospective (paying for future work) and involve extensive proposals, while challenges are often retrospective (paying for results) and focus on solutions.
Does the applicant have to be in one of the “geographic areas of interest” to be eligible? Does the applicant have to be on the national CCH mapto be eligible?
- Organizations do not need to be in a geographic area of interest to be eligible.
- Organizations do not have to be listed on the national map of CCHshosted by USAging to be eligible (but if they are a CCH, we would encourage them to submit their information to USAgingto be included on the map).
- ACL invites Challenge teams from all regions that demonstrate a high level of readiness and opportunity to address Challenge goals consistent with the factors used to identify the geographies of interest. All applicants will be judged according to the same criteria (see judging criteria).
For community care hubs that are not located in a geographic area of interest, can you provide more detail on expectations regarding market penetration and CMS Star rating gaps?
The following considerations influenced ACL’s analysis of geographic areas of interest:
- Market penetration: Definitions vary, but some geographies of interest demonstrate 50%-60%+ of Medicare beneficiaries in Medicare Advantage, 50%-60%+ of Medicare fee-for-service beneficiaries in an ACO, and 30%-40%+ of dual-eligibles in D-SNPs.
- Market performance: Applicants should identify opportunities to improve health care quality as specified by existing performance gaps noted from HEDIS, CAHPS, Star Ratings, Medicare ACO, or other quality measures for care coordination, care transitions, and management of diabetes, heart disease, pain management, arthritis, falls, etc.
Is there a minimum size for the geographic area served, or for the number of individuals reached?
ACL has set an ambitious goal to achieve community-clinical integration for up to one million dually eligible and near-dually eligible Medicare and Medicaid beneficiaries. Challenge submissions should thus reflect ambitious yet achievable targets, with the capacity to serve a large geographic reach, whether regional, statewide, or across multiple states. Geography should be large enough to reach a significant proportion of dually eligible and near-dually eligible beneficiaries.
How is “near-dually eligible” being defined?
Near-dually eligible individuals are Medicare-only beneficiaries with low incomes who do not qualify for full Medicaid but are at high risk of needing it, often facing challenges paying for care. They differ from dual eligibles by lacking Medicaid coverage, making them ineligible for Medicaid-covered long-term services, yet they often live at or near the poverty level.
How is the prize money distributed across Challenge winners?
- At the end of Phase 1, up to $2 million in total prizes will be awarded to a maximum of 10 teams. The $2 million will be distributed equally across the winning teams.
- At the end of Phase 2, up to $2 million in total prizes will be awarded to a maximum of 5 teams. The $2 million will be distributed equally across the winning teams. Additionally, up to three Phase 2 teams could each be eligible for a meritorious prize of up to $50,000 for one of the following focus areas:
  - Implementation of AI to enable community-clinical integration and coordinated service delivery for dually eligible and near-dually eligible beneficiaries
  - Innovative approaches to reach the near-dually eligible beneficiaries with complex needs and at risk for spend down to Medicaid eligibility
- At the end of Phase 3, up to $2 million in total prizes will be awarded to a maximum of 3 teams. The $2 million will be distributed equally across the winning teams. Additionally, up to three Phase 3 teams could each be eligible for a meritorious prize of up to $50,000 for one of the following focus areas:
  - Implementation of AI to enable community-clinical integration and coordinated service delivery for dually eligible and near-dually eligible beneficiaries
  - Innovative approaches to reach the near-dually eligible beneficiaries with complex needs and at risk for spend down to Medicaid eligibility
Is a budget required with the application?
No. Challenge submissions do not need a budget.
Can an organization submit or be part of the Challenge team in multiple entries?
Multiple entries are permitted. Each solution must be sufficiently novel and unique and not be a minor modification of a prior submission.
Are for-profit entities eligible applicants?
While most community care hubs are nonprofit, hubs that are structured as for-profit organizations are eligible to apply, assuming they meet the requisite definition and criteria.The community care hub must be connected to an area agency on aging, an aging and disability resource center, a center for independent living, or another aging or disability network organization.
Can applicants enter directly into Phase 2 or Phase 3?
No. Submitting teams are only eligible to compete for Phases 2 and 3 of the Challenge if they are selected as a winner in the previous phase. Only Phase 1 winners are eligible for Phase 2; only Phase 2 winners are eligible for Phase 3.
If selected as a winning team for Phase 1, does that automatically qualify us for Phase 2? If selected as a winning team for Phase 2, does that automatically qualify us for Phase 3?
Yes, Phase 1 winners are automatically qualified for Phase 2 and Phase 2 winners are automatically qualified for Phase 3.
How long is Phase 1?
Phase 1 is considered between now and the due date for submission of Phase 1 applications (5:00 p.m. ET on June 24, 2026). Phase 2 will start after the announcement of Phase 1 winners.
What is the role of state government in the Health at Home Challenge?
If the lead applicant is an area agency on aging, they are encouraged to discuss their plans to participate in the Challenge with their respective state unit on aging, including how to address conditions associated with contracts and commercial relationships in their state. Challenge team leads are also encouraged to consider strategies in their state or area to integrate care for dually eligible Medicare and Medicaid populations in developing their implementation strategies.
Are there administrative and reporting requirements if awarded? Are there any restrictions on how the funds can be used?
- This opportunity is structured as a prize challenge, which is distinctly different from a grant or a contract. The prizes are awarded based on the quality of your submission, measured against the judging criteria. You do not need to submit a budget, and there are no requirements for how the prize money can be used.
- There is no requirement to continue to participate in Phases 2 or 3 if a team is a winner in Phases 1 or 2, though we certainly hope winning teams will continue their work in subsequent phases.
- There are no reporting requirements after the award, but to be eligible for Phases 2 and 3, the Challenge team must agree to participate in an external evaluation to measure the impact of services delivered to dually eligible and near-dually eligible beneficiaries. ACL will make available technical assistance to Phase 1 winners to support their success in Phase 2, but there is no requirement to participate.
Is technical assistance available for Challenge applicants?
Technical assistance is not available for Phase 1 applicants, but will be made available to Phase 1 and Phase 2 winning teams.
Can applicants use non-governmental funding sources (e.g., accelerators, grants) alongside this prize?
- Applicants can use non-governmental funds to support their Challenge submission.
- The Eligibility and Terms tab of the Challenge website provides information on the use of federal grants and contracts in support of a Challenge submission.
When will the judging criteria be available for Phases 2 and 3?
- Judging criteria for Phase 2 will be available in May 2026.
- Judging criteria for Phase 3 will be announced at a later date.
Where can I find the recording for the May 5 informational webinar?
- The recording is available on the Health at Home Challenge website.