Sections 1115, 1915 explained: 4 ways states are using Medicaid waivers

As President Donald Trump's administration seeks to reduce government oversight at the state level, several states are pursuing Medicaid waivers to test care delivery models, according to a recent analysis from health plan software provider RAM Technologies.

Under the Social Security Act, HHS can waive provisions of Medicaid and the Children's Health Insurance Program. Available waivers under the Social Security Act include the following, listed by the section of the Social Security Act permitting them: 1115, 1915(a), 1915(b) and 1915(c).

Section 1115 waivers allow states to implement projects concerning Medicaid eligibility, benefits, delivery systems and payment, according to the analysis. Section 1915(a) waivers let states implement voluntary managed care programs, while 1915(b) waivers allow states to roll out mandatory managed care models. Section 1915(c) waivers let states extend home- and community-based service coverage for beneficiaries with brain injuries or developmental and intellectual disabilities, as well as disabled and elderly populations.

Here are four ways states are using these Medicaid waivers, as examined by RAM Technologies.

1. Thirty-three states gained approval for 41 section 1115 waivers as of September 2017.

2. Some states have used 1115 and 1915 waivers to help fund new healthcare delivery and reimbursement models. Since 2009, Rhode Island has operated its Medicaid as a modified block grant program under an 1115 waiver, for example.

3. States have also used the waivers to extend healthcare coverage, add benefits, mandate cost sharing and expand emergency care coverage. The first state to expand Medicaid eligibility under the ACA through an 1115 waiver was Arkansas. The state used federal funds to subsidize private health insurance for newly eligible beneficiaries. Arizona, Indiana, Iowa, Michigan, Montana and New Hampshire also obtained 1115 waivers for Medicaid expansion, allocating funds toward insurance premiums, cost-sharing initiatives and healthy behavior incentives.

4. As the opioid epidemic rages, states are increasingly seeking funding for innovative programs under 1115 waivers, according to the report.

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