Medicaid Waivers

Waivers

Waivers are vehicles states can use to test new or existing ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP). There are four primary types of waivers and demonstration projects:

Section 1115 Research & Demonstration Projects: States can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP.

Section 1915(b) Managed Care Waivers: States can apply for waivers to provide services through managed care delivery systems or otherwise limit people’s choice of providers.

Section 1915(c) Home and Community-Based Services Waivers: States can apply for waivers to provide long-term care services in home and community settings rather than institutional settings.

Concurrent Section 1915(b) and 1915(c) Waivers: States can apply to simultaneously implement two types of waivers to provide a continuum of services to the elderly and people with disabilities, as long as all Federal requirements for both programs are met.

CMS Waiver Section 1115 Demonstrations

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs. The purpose of these demonstrations, which give States additional flexibility to design and improve their programs, is to demonstrate and evaluate policy approaches such as:

  • Expanding eligibility to individuals who are not otherwise Medicaid or CHIP eligible
  • Providing services not typically covered by Medicaid
  • Using innovative service delivery systems that improve care, increase efficiency, and reduce costs.

In general, section 1115 demonstrations are approved for a five-year period and can be renewed, typically for an additional three years. Demonstrations must be “budget neutral” to the Federal government, which means that during the course of the project Federal Medicaid expenditures will not be more than Federal spending without the waiver.

Final Rule-Review and Approval Process for Medicaid and CHIP Section 1115 Demonstrations

Section 1115 Demonstration Transparency State Health Official Letter

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.html

Approved Demonstrations Offer Lessons for States Seeking to Expand Medicaid Through Waivers

PDF of this report (7pp.) By Jesse Cross-Call and Judith Solomon August 20, 2014

 

Texas Healthcare Transformation and Quality Improvement Program Medicaid 1115 Waiver (PPT February 2012)

Donna Sollenberger
EVP, CEO Health System
UTMB Health

http://www.utmb.edu/1115/docs/1115Waiver-CommunityPresentation-2012-02-21.pdf