Washington's Apple Health and Homes treats housing as health care KFF analysis suggests that Hispanic children may be more likely to experience income volatility or lose coverage at renewal for procedural reasons than children of other races, so these policies may also reduce racial disparities and promote health equity. The Families First Coronavirus Response Act (FFCRA) enacted at the start of the COVID-19 pandemic included a requirement that state Medicaid programs keep people continuously enrolled in exchange for enhanced federal matching funds. A .gov website belongs to an official government organization in the United States. The recent OR waiver approval included CE for children through age 6 and two-year CE for all enrollees above age 6. Six states (KS, MA, NJ, NY, OR and WA) have approved waivers and one state (NM) has a pending request to extend continuous eligibility beyond what is allowed under federal law (Table 1). PDF CMS Manual System - Centers for Medicare & Medicaid Services Without a waiver, federal financial participation would not be available for these services. Arkansas, Arizona, Massachusetts, and Oregon each gained approval to finance a suite of services aimed at HRSN. Share on Facebook. How States Apply; Transparency; 1115 Demonstration Monitoring & Evaluation; State Waivers List; 1115 Substance Use Disorder Demonstrations; Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations; Health Related Social Needs; Managed Care. State Waivers List. A .gov website belongs to an official government organization in the United States. Texas loses 1115 waiver for health care for low-income, uninsured As of January 2023, 33 states have adopted the option that is available under current law to provide 12-month continuous eligibility for some or all children in Medicaid and/or CHIP. States are also encouraged to use the accompanying budget neutrality templateto develop their own applications. Section 1115 Waiver Watch: Continuous Eligibility Waivers and Implications for Unwinding. Just as the regional/organizational structures of DSRIP entities vary state-by-state, so too do the eligible participants that can partake in DSRIP projects and receive funding, the details of which are discussed in Table 3. Applicable participants were designated by each state to best meet the needs of their target populations, including Medicaid beneficiaries in all cases, but also varying degrees of dual-eligibles, uninsured and even Medicare beneficiaries. These waivers also vary by: Looking ahead, continuous eligibility policies will remain an important lever for stabilizing Medicaid coverage, following the unwinding of the continuous enrollment provision. In addition to the type of Section 1115 Waivers noted above, states have also been granted waivers under Section 1115 authority to expand Medicaid to provide assistance to uninsured and underinsured patients in paying their health insurance premiums, or other similar waiver programs. Secure .gov websites use HTTPS Share on Facebook. 12/1/2015 Town Hall: Combined Section 1115 Waiver MLTSS and DSRIP Charlottesville 12/2/2015 Town Hall: Combined Section 1115 Waiver MLTSS and DSRIP . A program authorized under 1115 of the Act. Heres how you know. Share sensitive information only on official, secure websites. The U.S. Department of Health and Human Services (HHS) has discretion to approve these demonstration, and, as seen from the history of work-requirement waivers, each administration develops its own waiver policies and . For all four states, CMS approved expenditure authority for HRSN services and infrastructure, with states required to monitor and evaluate the impact of these services on program costs. . Notable Section 1115 SDOH provisions approved prior to 2022 include: In addition to these and more recent approvals, 8 states are requesting CMS review of pending SDOH provisions. Legislative actions and the status of Section 1115 waivers are Moreover, addressing peoples underlying health needs enhances their ability to succeed and thrive during reentry, thereby lowering the risk of recidivism, helping make our communities healthier and safer. About Section 1115 Demonstrations | Medicaid State Options for Extending Medicaid Postpartum Coverage Under a continuous coverage policy, individuals who are determined to be eligible can maintain Medicaid coverage for a specific period of time, regardless of fluctuations in income, before a redetermination period to determine ongoing eligibility. The evaluation requirements include a schedule of deliverables, including quarterly and annual monitoring reports as well as interim and final evaluation reports. According to the U.S. Department of Justice, from 2011 to 2012, approximately 37 percent of people in state/federal prisons and 44 percentof people who were incarcerated overall had a history of mental illness. It is plausible, for example, that some states may have committed to implementing certain policies through 1115 waivers, but are failing to comply States can elect a state plan option to provide 12-month continuous eligibility (CE) to children in Medicaid but not other populations. Our Scorecard ranks every states health care system based on how well it provides high-quality, accessible, and equitable health care. Section 1115 demonstration waivers provide states an avenue to test new approaches in Medicaid and generally reflect changing priorities from one presidential administration to another. The American Rescue Plan Act (ARPA) gave states the option to extend postpartum Medicaid coverage from the federal minimum of 60 days to a full 12 months by submitting a state plan amendment, a less rigorous and time-consuming process than the section 1115 demonstration waivers states have previously used to extend postpartum coverage. At the federal level, CMS must post all waiver application-related documents and correspondence on Medicaid.gov, among other requirements (CMS 2012). Section 1115 Waiver Watch: Continuous Eligibility Waivers and - KFF States cannot provide continuous coverage to children or postpartum individuals for longer than 12 monthsor to other adults at allwithout a waiver. Section 1115 waivers allow states to obtain federal approval to operate their Medicaid programs in ways that differ from what is required by federal statute. This guidance outlines a pathway to implement historic changes for individuals who are incarcerated and eligible for Medicaid. 5103 (c), PHMSA has authority delegated by the Secretary (49 CFR l.97 (b) (3)) to a waive compliance with any . CMS approval comes with certain guardrails: Additional initiatives in these waivers include: CMS is permitting substantial flexibility in programmatic design to allow states to undertake transformative initiatives. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KFF | twitter.com/kff. DATES: Through Section 1115 Medicaid demonstration waivers, states are allowed to make programmatic changes that are not otherwise permitted under federal law, provided the changes promote the. Section 1115 waivers have been used in the past to allow states to draw down Medicaid funds to pay hospitals for care provided to the uninsured. An official website of the United States Government . To learn more, read the complete State Medicaid Direct Letter on Medicaid.gov. PDF Primer: State Plan Amendments v. Section 1115 Waivers Emergency Waiver Order #26: Transporting Hazmat in Hawaii However, in addition to state plan and managed care options, states can request Section 1115 waiver authority to add certain non-clinical services to the Medicaid benefit package. Section 1115 Demonstrations | Medicaid CMS notes that research shows that increasing Medicaid payments to providers improves beneficiaries access to health care services and the quality of care received., In addition to HRSN services, CMS approved continuous eligibility provisions for MA and OR and is continuing to work with these and other states on pre-release requests. States may define eligibility for HRSN services, subject to CMS approval. Secure .gov websites use HTTPS Section 1115 of the Social Security Act authorizes HHS to waive certain provisions of the Medicaid Act to allow states to implement "experimental, pilot, or demonstration projects" that are likely to promote the objectives of the Medicaid Act. An official website of the United States government Share sensitive information only on official, secure websites. A .gov website belongs to an official government organization in the United States. 4 Under current law, states have the option to extend 12-month continuous eligibility for children and for postpartum coverage. Section 1115 demonstrations (also called waivers) allow states to test new ways to operate their Medicaid programs, typically on matters related to eligibility, benefits, and care delivery. For example, states must regularly collect and report data that will answer questions about the number of enrollees served by the HRSN initiatives; the prevalence and severity of the enrollees social needs; enrollee utilization of preventive and routine care as well as potentially avoidable, high-acuity health care; and the cost-effectiveness of the HRSN initiatives. community-based services (HCBS) waiver. In this brief, the focus will be on state programs that COPE Health Solutions has worked extensively with, specifically California, New York, Texas and Washington3, but with a nod to other states with approved past and current DSRIP programs, including Alabama, Arizona, Massachusetts and New Jersey. Improving Maternal Health Extending Medicaid Postpartum Coverage Official websites use .gov This Waiver Watch summarizes approved and pending Section 1115 demonstration waivers in seven states with continuous eligibility provisions that could help minimize coverage loss. TANF funding. Section 1115 Waiver Watch: Approvals to Address Health-Related Social Needs. ) or https:// means youve safely connected to the .gov website. Lock "1115" is the section of the Social Security Act that outlines the purposes and limitations of these waivers. Medicare Program; Medicare Disproportionate Share Hospital (DSH A state must solicit significant public input by using multiple methods for public notification (like electronic mailing lists and notices in newspapers) and having a 30-day comment period before submitting the proposal to CMS. For example, New York recently requested a Health Equity Reform amendment that would establish regional organizations to coordinate health equity improvement initiatives and provide evidence-based interventions to address social care needs. This document provides the statutory language in effect as of December 1, 2009, and may be helpful to section 1115 demonstration states analyzing benefits provided to certain demonstration eligible as of that date. More specific evaluation criteria include the promotion of coverage for low-income individuals, increased access to care, increased efficiency and quality of care and improved health outcomes (as measured by quality measures). The MA approval included 12-month CE for enrollees upon release from correctional settings and 24-month CE for enrollees experiencing homelessness. based on clinical and social risk factors, meaning that these services are not for everyone in the Medicaid program. On August 10, 2023, the President issued a Major Disaster Declaration for the Hawaii Wildfires for the State of Hawaii (DR-4724-HI). Finally, to ensure that waiver funding for HRSN services adds to the resources available to address social needs, the waivers do not permit states to supplant existing funding with the new waiver funds. We are committed to ensuring all Americans have the peace of mind they deserve knowing they have access to life-saving health care, whether it is medication-assisted treatment for substance use disorders or prescription medication to treat other chronic health conditions. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KFF | twitter.com/kff. The common thread of 1115 waivers is the enablement of states to pilot innovative and experimental approaches, granted they align with the mission and vision of Medicaid and/or CHIP. Section 1115 demonstrations (also called "waivers") allow states to test new ways to operate their Medicaid programs, typically on matters related to eligibility, benefits, and care delivery. Authors. The independent source for health policy research, polling, and news. Section 1115 Medicaid Demonstration Waivers: The Current - KFF Both states and the federal government have identified addressing social determinants of health (SDOH) as a key Medicaid priority. Uncompensated Care Pool Waivers Undermine Health Coverage for the 200 Independence Avenue, S.W. School district calls emergency meeting over fate of Parma high - MSN 5121-5207 (the Stafford Act). Recently, seven states have sought such waivers to provide continuous eligibility that is more generous than otherwise allowed, for children (3 states) and/or adults (5 states). Through this historic new effort, we are working to ensure that people who were formerly incarcerated can transition successfully back into the community with the health care supports and services they need. States are also encouraged to use the accompanying in developing their applications. States that want to be considered for the fast track process must use the streamlined extension application for the 1115 extension pathway it is requesting to be extended under. Share on Facebook. Recognizing that many providers offering HRSN services are community-based organizations and need new capabilities to participate, all four states have approval to invest additional Medicaid funds in HRSN infrastructure, ranging from workforce to data systems. By definition, DSRIP is an incentive-based funding program, thus participants draw down dollars from the state by meeting predetermined implementation milestones and clinical outcomes, as outlined in projects that guide the work. Section 1115 waivers make it possible for states to seek approval from the Centers for Medicare and Medicaid Services (CMS) to test innovative approaches to delivering Medicaid services.. Published: Nov 15, 2022. Section 1915(c) of the Social Security Act authorizes the . For the recent AR, AZ, MA, and OR approvals, CMS is applying annual aggregate budget neutrality spending caps to HRSN service expenditures for which each state may receive federal financial participation (Table 2). You may request a copy of the proposed renewal request, notices and/or a copy of submitted public . Foundational Community Supports operates under a Medicaid Section 1115 demonstration waiver, which enables states to use Medicaid funding for services that wouldn't traditionally be permitted by . An official website of the United States government. At the same time, by establishing new guardrails and conditions, CMS is balancing that flexibility with constraints and new obligations. An official website of the United States government, Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs, Promoting Community Integration Through Long-Term Services and Supports, Eligibility & Administration SPA Implementation Guides, Medicaid Data Collection Tool (MDCT) Portal, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Unwinding and Returning to Regular Operations after COVID-19, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Medicaid and CHIP Quality Resource Library, Lawfully Residing Immigrant Children & Pregnant Individuals, Home & Community Based Services Authorities, April 2023 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Budget & Expenditure Reporting for Medicaid and CHIP, CMS-64 FFCRA Increased FMAP Expenditure Data, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time, Medicaid Managed Long Term Services and Supports (MLTSS). Starting April 1, 2023, states can resume Medicaid disenrollments for the first time in three years. NC Section 1115 Demonstration Waiver | NC Medicaid

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