The Medicaid Reentry Section 1115 Demonstration Opportunity will allow states to cover a package of pre-release services for up to 90 days prior to the individuals expected release date that could not otherwise be covered by Medicaid due to a longstanding statutory exclusion that prohibits Medicaid payment for most services provided to most people in the care of a state or county carceral facility. State Options for Extending Medicaid Postpartum Coverage Final Rule-Review and Approval Process for Medicaid and CHIP Section 1115 Demonstrations. Four months later, the Trump administration CMS issued guidance inviting states to apply for section 1115 waivers to "provide cost-effective coverage using flexible benefit designs under either an aggregate or per-capita cap financing model" for non-elderly, non-disabled adults, including Medicaid expansion adults. The size of the investments varies according to the states Medicaid population and the differences in the population groups that are the focus of the interventions. Section 1115 demonstration waivers : MACPAC For a comprehensive Section 1115 waiver, each program element must be separately understood, discussed, and negotiated. Section 1115 Demonstrations State Waivers List Section 1115 demonstrations and waiver authorities in section 1915 of the Social Security Act 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). Opens in a new window. The scope of services provided and populations targeted by these waiver provisions vary and are very narrow in some states; also, these may overlap with HCBS programs in some instances. PDF Notice Number 2023-179 Rule Number He-M 1401 1. Agency Name & Address States use section 1115 demonstrations (also known as "waivers") to test innovations in their Medicaid programs. Raleigh, NC 27699-1950. Both states and the federal government have identified addressing social determinants of health (SDOH) as a key Medicaid priority. It allows a state to waive certain Medicaid requirements for projects that are "likely to promote the objectives of the Medicaid program". In March 2019, CMS issued evaluation and monitoring guidance designed to strengthen expectations for states implementing certain types of demonstrations. 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. For example, states used Section 1115 waivers to provide targeted benefits to individuals with HIV/AIDS, mandate enrollment in a specific capitated managed care plan, and increase cost sharing for certain populations. The final point above, delivery system reform, is particularly interesting due to its ability drive larger health system transformation. Key themes in current approved and pending waivers include targeted eligibility expansions, benefit expansions (particularly in the area of behavioral health, such as coverage of services provided in IMDs), and provisions related to social determinants of health. 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 . 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. The Biden Administration has encouraged states to propose waivers that expand coverage, reduce health disparities, and/or advance whole-person care, including by addressing health-related social needs (HRSN). This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. . New guidance can help people at high risk of substance use disorders and other health conditions get the care they need, especially as they transition from incarceration back to the community. Section 1115 demonstrations and waiver authorities in section 1915 of the Social Security Act are vehicles states can use to test new or existing ways to deliver and pay for health care services in Medicaid and the Childrens Health Insurance Program (CHIP). The federal funding share is 66% to a maximum of $2 million for the duration of the project. For more information on the fast track review process, please review theCMCS Informational Bulletinreleased July 24, 2015. For more information, please contact info@copehealthsolutions.com. 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). At the most basic level, continuous enrollment that is, keeping Medicaid coverage in place without regard to changes in circumstances or paperwork requirements avoids disruptions in coverage and care. 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. The waiver, which has operated since 1997, has . Overview of the ACA Medicaid Expansion - CRS Reports Effective April 27, 2012, in accordance with section 10201(i) of the Affordable Care Act that set forth transparency and public notice requirements for section 1115 demonstrations, states will need to include the following components in demonstration applications for CMS to consider the application submission complete for the purpose of initiating federal review. Learn More. As noted above, the CAAmandates all states to implement 12-month continuous eligibility for children in Medicaid and CHIP, starting in 2024. KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 The independent source for health policy research, polling, and news. While HRSN service offerings are different in each state, all four states will provide housing-related services to help individuals secure housing, turn on utilities, and avoid eviction. Services to amen d the Substance Use Disorder Treatment and Recovery Access Section 1115(a) Research and Demonstration Waiver. 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. 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). A section of the waiver reads: "The Commission, by resolution dated February 18, 1999, established a threshold to replace rather than repair or reconstruct CFAP Projects. Heres how you know. 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. 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. Recently, the Centers for Medicare and Medicaid Services (CMS) approved the renewal of and amendments to section 1115 demonstrations for Arkansas, Arizona, Massachusetts, and Oregon, all of which include innovative features. A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, 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, COVID-19 1115 Waiver Demonstration Template, Healthy Adult Opportunity Section 1115 Demonstration Application Template, State Medicaid Director Letter Healthy Adult Opportunity, States That Provide Medicaid Coverage for New Adult Group, States That Do Not Provide Medicaid Coverage for New Adult Group, A comprehensive program description of the demonstration, including the goals and objectives to be implemented under the demonstration project, A description of the proposed health care delivery system, eligibility requirements, benefit coverage and cost sharing (premiums, copayments, and deductibles) required of individuals who will be impacted by the demonstration to the extent such provisions would vary from the states current program features and the requirements of the Social Security Act, An estimate of the expected increase or decrease in annual enrollment, and in annual aggregate expenditures, including historic enrollment or budgetary data, if applicable, Current enrollment data, if applicable, and enrollment projections expected over the term of the demonstration for each category of beneficiary whose health care coverage is impacted by the demonstration, Other program features that the demonstration would modify in the states Medicaid program and/or CHIP, The specific waiver and expenditure authorities that the state believes to be necessary to authorize the demonstration, The research hypotheses that are related to the demonstrations proposed changes, goals, and objectives; a plan for testing the hypotheses in the context of an evaluation; and, if a quantitative evaluation design is feasible, the identification of appropriate evaluation indicators, Written documentation of the states compliance with the public notice requirements, with a report of the issues raised by the public during the comment period, which shall be no less than 30 days, and how the state considered those comments when developing the demonstration application, A historical narrative summary of the demonstration project, which includes the objectives set forth at the time the demonstration was approved, evidence of how these objectives have or have not been met, and the future goals of the program, If changes are requested, a narrative of the changes being requested along with the objective of the change and the desired outcomes, A list and programmatic description of the waivers and expenditure authorities that are being requested for the extension period, or a statement that the state is requesting the same waiver and expenditure authorities as those approved in the current demonstration, Summaries of External Quality Review Organization reports, managed care organization and state quality assurance monitoring, and any other documentation of the quality of and access to care provided under the demonstration, Financial data demonstrating the states historical and projected expenditures for the requested period of the extension, as well as cumulatively over the lifetime of the demonstration. A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, 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, AL Community Transition (ACT) Waiver (0878.R02.00), AL Community Waiver Program (1746.R00.00), AL HCBS Living at Home Waiver for Persons with Intellectual Disabilities (0391.R04.00), AL Home and Community Based Services Waiver for Individuals with HIV/AIDS and Related Illnesses (40382.R02.00), AL Home and Community-Based Waiver for Persons with Intellectual Disabilities (0001.R09.00), AL Home and Community-Based Waiver for the Elderly and Disabled (0068.R08.00), AL Technology Assisted (TA) Waiver (0407.R04.00).

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