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Recent State Activities on Section 1115 Medicaid Waivers

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Recent State Activities on Section 1115 Medicaid Waivers

January 3, 2012

As of April 2011, at least 30 states and the District of Columbia were operating one or more Section 1115 Medicaid waivers: 10 of which are primarily managed care; an additional 10 primarily expand coverage to non-disabled parents and/or other adults; two establish global caps on Medicaid funds (Vermont and Rhode Island); and five extend coverage to adults as part of a broader expansion effort.

Earlier this month, ANCOR forwarded you information, including the Centers for Medicare and Medicaid Services approval letter on the Texas Section 1115 managed care waiver modeled somewhat on a waiver that has been underway in California since November 2010. In late October, CMS approved a controversial Medicaid waiver for California, which allowed the state to make massive cuts in its payments to doctors. These five-year waiver demonstrations are approved under section 1115 of the Social Security Act and waive certain federal Medicaid requirements to enable states to conduct demonstrations with federal Medicaid funds. These two waivers have important similarities, including capitated managed care expansions for some seniors and individuals with disabilities.

CMS approved an extension of a Medicaid waiver in Massachusetts, which was first implemented as part of then Governor Mitt Romney’s healthcare overhaul. The waiver, which will now run through 2014, is focused primarily on efforts to improve the cost and quality of the Medicaid program and better coordinate care, providing incentives for hospitals to improve their efforts to integrate their services.

Below are new resources regarding the Texas and California waivers:

  • A fact sheet contrasting key provisions of the California and Texas Section 1115 Medicaid demonstration waivers.

  • An issue brief that provides a focused overview of California’s waiver.

  • Fact sheets on the Texas and California healthcare landscapes, including data on demographics, population health, the uninsured and Medicaid.

Additionally, Florida’s 2011 legislature has called for mandatory enrollment in managed care for most Medicaid beneficiaries, including long-term services for some individuals, beyond the five-year pilot programs through an 1115 waiver that replaced traditional Medicaid in 2005.

What changes are in store for Florida’s Medicaid program?

Check out these resources:

Note:Kaiser prepared an issue brief, Five Key Questions And Answers About Section 1115 Medicaid Waivers, which is very helpful in understanding the Section 1115 Medicaid demonstration waivers more generally.