Tag Archives: Waivers

Trump Administration Offers States New Medicaid “Healthy Adult Opportunity” Demonstration with Enhanced Benefit, Payment Flexibilities

The Centers for Medicare & Medicaid Services (CMS) has announced a controversial plan to allow states to apply to participate in a new Medicaid “Healthy Adult Opportunity” (HAO) Demonstration.  In short, the HAO Demonstration will give participating states greater flexibility in the scope and administration of Medicaid benefits for certain beneficiary populations (i.e., the Affordable … Continue Reading

CMS Clears the Way for States to Add Medicaid Work/Community Engagement Requirements

CMS has announced a new initiative allowing states to propose demonstrations to “improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” Specifically, states may propose Section 1115 waivers to make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for non-elderly, non-pregnant adult Medicaid beneficiaries who … Continue Reading

Trump Administration Signals More Administrative Flexibility for State Medicaid Programs, with Emphasis on “Most Vulnerable Populations”

In her first act as CMS Administrator, Seema Verma joined HHS Secretary Tom Price in writing to the nation’s Governors to urge collaboration on improving the Medicaid program, with an emphasis on services for “truly vulnerable” populations. Price and Verma contend that the “expansion of Medicaid through the Affordable Care Act (ACA) to non-disabled, working-age … Continue Reading

HHS, Treasury Issue Guidance on ACA State Innovation Waivers

The Departments of Health and Human Services (HHS) and Treasury have issued joint guidance on Affordable Care Act (ACA) “Section 1332” waivers, through which states can apply to implement alternative mechanisms to provide access to health care for their residents if certain conditions are met.  Under the ACA, Section 1332 waivers can only be approved … Continue Reading

GAO Calls for Tighter Reins on Section 1115 Demonstrations

A recent GAO report examined expenditure authorities in “section 1115” demonstrations approved by HHS between June 2012 and October 2013. Section 1115 of the Social Security Act gives HHS broad authority to approve “expenditure authorities” that allow states to receive federal funds for costs that would not otherwise be matchable under Medicaid if the Secretary … Continue Reading

CMS Finalizes Rule to Strengthen Home- and Community-Based Services (HCBS) Options

On January 16, 2014, CMS published a final rule that implements expanded federal support for HCBS offered as an optional benefit through state Medicaid programs, as authorized by the Affordable Care Act (ACA) and the Deficit Reduction Act. Specifically, the rule establishes eligibility requirements for Medicaid HCBS provided under sections 1915(c), 1915(i), and 1915(k) of the … Continue Reading

OIG Recommends Enforcement of Federal Standards for HCBS in Assisted Living Facilities

A recent OIG report examined the extent to which home and community-based services (HCBS) for beneficiaries residing in assisted living facilities (ALF) furnished under a section 1915(c) waiver comply with federal and state requirements. Based on sample of 150 beneficiaries in the seven states with the highest numbers of beneficiaries receiving HCBS in ALFs (Georgia, … Continue Reading

OIG, GAO Review Medicaid HCBS Programs

The OIG has issued a report that assesses state oversight of services provided through 1915(c) home and community-based services (HCBS) waiver programs.  According to the OIG, seven of the 25 states reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries through these waiver programs.  Moreover, while CMS renewed the … Continue Reading

HHS Issues Final Rule on Framework For State Health Reform Innovation Waivers

HHS published a rule on February 27, 2012 that implements the procedural framework for submission and review of State Innovation Waiver applications under section 1332 of the ACA, effective April 27, 2012. Under the rule, states will have flexibility to apply for a State Innovation Waiver to pursue their own strategies to provide their residents … Continue Reading

CMS Proposes Revisions to Rules for Medicaid Home and Community-Based Services (HCBS) Waivers

CMS has issued a proposed rule that would provide states with additional flexibility in obtaining waivers to offer Medicaid HCBS. Among other things, the rule would: allow states to combine more than one target population in a single waiver if certain conditions are met; promote person-centered service and support plans; describe characteristics of settings that are not … Continue Reading

HHS Proposes Framework For State Health Reform Innovation Waivers

The Department of Health and Human Services (HHS) has published a proposed rule to implement the procedural framework for submission and review of State Innovation Waiver applications under section 1332 of the Affordable Care Act (ACA). Under the rule, states would have flexibility to apply for a State Innovation Waiver to pursue their own strategies to … Continue Reading