Health care and medicaid demonstration waivers

Section Review Process In recognition of the potential that individual State initiatives can offer, DHHS is committed to streamlining the section waiver process, and has implemented procedures to minimize the administrative burden on the States and reduce the processing time for waiver requests.

Documentation of meeting this requirement is required to remain eligible for coverage. How have waivers been used in the past?

Medicaid waivers by state

The State may notify the public of the demonstration proposal and acquire public input through the following means: public hearings; developing the proposal through a commission that holds open meetings; providing for formal notice in accordance with State notice and comment requirements; announcing the intent to submit a proposal in a newspaper of general circulation; or, any other process which affords interested parties the opportunity to learn about and comment on the State's proposal. Agency for Health Care Administration; Feb, If approved, these proposals would substantially reduce coverage and impose significant barriers to needed care. Endnotes Section Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Based on waiver results, states or CMS may change the program. Waivers can provide states considerable flexibility in how they operate their programs, beyond what is available under current law. Throughout this process, Federal staff and State representatives continue discussing any remaining issues. What is the process to receive public input on new waivers, amendments, and operational protocols? Related Federal Statute Restrictions State efforts to implement comprehensive reforms to their Medicaid programs through section waiver programs have been impacted by the effects of other Federal statutes that regulate health care financing and delivery. Authority and Purpose. Most waivers were small in scope until the s, when states started to use them for a wide range of purposes , including to: expand eligibility, simplify the enrollment and renewal process, reform care delivery, implement managed care, provide long-term services and supports, and alter benefits and cost-sharing. Another method for allowing ex post variation in the expenditure limit is to tie the limit to a medical price index. They should not cause fewer people to get or retain coverage or make it harder to obtain necessary health care. The Secretary of Treasury is also involved in approving marketplace waivers.

Additionally, HCFA may alert the State to problematic aspects of its proposed program that might violate HCFA principles, for example, the utilization of block grants or enhanced Federal matching rates.

Waivers should not limit participation or purport to test policies already shown to limit coverage and access to care.

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Examples of combined Medicare-Medicaid waiver projects include: Massachusetts Senior Care Options : Fully integrated managed care program, offered through Senior Care Organizations SCOs , covering the full range of acute and long-term care benefits for dually eligible and Medicaid-only recipients age 65 and over. Although detailed results from these demonstration programs will not be available for several years, there are a number of tentative lessons to be derived from the initial implementation of the programs. What data and reporting will be available prior to the completion of formal evaluations? In this regard, Medicaid demonstration waivers loomed large during the presidencies of Bill Clinton and George W. At the same time, they have not as some have suggested been a subterranean force for the erosion of Medicaid. Once approved, Medicare waiver projects are administered by CMS either directly, through contractors e. Unless the waiver includes a cap on the federal share of spending, there is no fiscal penalty if a demonstration is ultimately not budget neutral. This article documents and compares the volume and substance of section Medicaid waiver activity under the two presidencies. In Kentucky — the first state to have its work-requirement waiver approved — affected beneficiaries must complete 80 hours per month of community-engagement activities, such as employment, education, job skills training, or community service. If the projections upon which budget neutrality is based are too high, the result is a windfall for the State and a corresponding outflow of funds from the Federal Treasury ; if they are too low, serious fiscal problems for the State or cutbacks in services may result. The comment period ended on March 29, but to date the state has not submitted the proposal to CMS. MPR will also conduct a series of focus groups in each State for low-income clients, disabled clients, and physicians.

States can also change direction on waivers. From the perspective of policy performance, Medicaid demonstration waivers provide modest support for the view that states serve as laboratories for policy learning in the health care arena.

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Authority and Purpose. J Health Polit Policy Law. Historically rarer than Medicaid-only and Medicare-only demonstrations, combined waiver-based projects are increasingly popular as states develop integrated care models for dual eligibles and managed long-term care models.

In all States, the evaluators will examine the impact of the new organizational structures and payment reforms on health care organizations and providers. Each evaluation is a 5-year effort that will provide four annual reports and a final report Each report from the evaluation of the five State health reform demonstrations will contain a chapter on observations and analyses specific to each of the five demonstrations, as well as, a chapter with activities and findings related to cross-demonstration analyses.

The budget neutrality requirement applies only during the review process.

1115 waiver wikipedia

These include the advent and popularity of Medicare Advantage Special Needs Plans MA-SNPs , advances in risk adjustment methodologies and quality measurement, sharing of best practices, and collaborations among influential states, foundations , thought leaders , think tanks , and CMS. This can spark program improvements—indeed it is the most important resource for federal and state oversight. Each evaluation is a 5-year effort that will provide four annual reports and a final report Each report from the evaluation of the five State health reform demonstrations will contain a chapter on observations and analyses specific to each of the five demonstrations, as well as, a chapter with activities and findings related to cross-demonstration analyses. The first lesson, and probably the most obvious, is that the implementation of statewide reform initiatives is complex and difficult, and acceleration of program implementation may become problematic. That is, Medicaid or Medicare under the requested waivers must be projected to cost the applicable federal program no more than expected spending without the waivers. The Secretary of Treasury is also involved in approving marketplace waivers. Each of the evaluations also has unique features. Second, a shift from primarily fee-for-service delivery systems to managed-care models requires paying careful attention to the establishment of adequate organizational and administrative structures, as well as beneficiary outreach and education. Typically CMS and states engage in negotiations, and waivers are often changed during this process. Now, however, the Trump administration is encouraging states to apply for waivers that place new conditions on Medicaid eligibility as well as additional costs on beneficiaries in the form of premiums and copayments at the point of service. HCFA validates State assurances that preimplementation Special Terms and Conditions are met and assesses the State's operational readiness for project implementation. What happens after approval?
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Medicaid and State Health Care Reform: Process, Programs, and Policy Options