Transcript Slide 1
Medicaid Waivers Overview Kathryn Smith, RN, DrPH What is a Medicaid Waiver • A waiver is a document that asks the Federal government to waive a Medicaid rule in order to deliver care in a different way • Each state has a State Medicaid Plan that defines for the Federal government how the state will operate its Medicaid program • There are certain rules that each state must follow in its Medicaid program, for instance “statewideness” • If a state wants to experiment with a different way of delivering or paying for services, it must either submit a new State Medicaid Plan, or ask for one of the Medicaid rules to be waived • Waivers are typically used when the requested changes are not in alignment with current Medicaid rules 2 Types of Medicaid Waivers • • • • Section 1115 Research and Demonstration Waivers Section 1915 (b) Managed Care Waivers Section 1915 (c) Home and Community Based Services Waivers Concurrent Section 1915 (b) and 1915 (c) Waivers 3 Section 1115 Research and Demonstration Projects • States can apply for program flexibility to test new or existing ways of providing or financing care • Potential uses of an 1115 waiver by a state: – Expand eligibility to individuals who are not otherwise eligible – Provide services not typically covered by Medicaid – Use innovative service delivery methods to increase efficiency and decrease cost • Example is the CA Bridge to Health Reform, transitioning Healthy Families children and youth into Medi-Cal 4 Section 1915(b) Managed Care Waivers • States can apply to provide services through managed care organizations or otherwise limit people’s choices of providers • These can be used to: – Implement managed care that restricts providers – Allow a county or local government to aid people in choosing a managed care plan – Using the savings from managed care to provide additional services – Restrict the number of type of providers • An example is the CA HIV/AIDS waiver that provides enhanced case management and services to those with HIV/AIDS 5 Section 1915(c) Home and Community Based Services Waivers • States can apply to provide long term care services in the home or community settings, rather than institutions • States can offer a variety of services including standard medical services and non medical services including: case management, home health aide, homemaker, personal care, adult day health care and respite, as well as other services that would “divert” a person from an institution to home • An example in CA: the CA HCBS Waiver for Californians with Developmental Disabilities providing a full range of services to those with developmental disabilities 6 Concurrent Section1915(b) and 1915(c) Waivers • States can apply to implement two waivers at the same time to provide comprehensive services to the elderly and those with disabilities • States can provide traditional long term care services in the context of a managed care environment 7