Posted on July 22, 2011 13:06
Categories: Medicaid | State and Local
Topics: Health Care Reform | Medicaid
On June 3, the Kaiser Family Foundation (KFF) released a brief explaining Section 1115 Medicaid demonstration waivers, outlining how they are approved and financed, how states have used them, and how health reform affects them. KFF notes that the waivers have traditionally authorized the testing of novel coverage methods not normally allowed under Medicaid. The authors note that some states are now using the waivers to begin expanding health coverage under Medicaid in preparation for full implementation of health reform. In addition, the brief notes that some states use the waivers as a means to reduce costs and address budgetary shortfalls.
From the report:
For many years, Section 1115 waivers have been used in the Medicaid program to provide states an avenue to test and implement coverage approaches that do not meet federal program rules, but have also raised policy issues. Following are five key questions and answers about Section 1115 waivers:
What is a Section 1115 Medicaid demonstration waiver?
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Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to waive provisions of major health and welfare programs authorized under the Act, including certain Medicaid requirements, and to allow a state to use federal Medicaid funds in ways that are not otherwise allowed under federal rules. The authority is provided at the Secretary’s discretion for demonstration projects that the Secretary determines promote Medicaid program objectives.
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There are comprehensive Section 1115 Medicaid waivers that allow broad changes in eligibility, benefits, cost sharing, and provider payments. There also are more narrowly drawn Section 1115 waivers as well as Section 1915 Medicaid waivers that focus on specific services and populations.
Full Report: Five Key Questions and Answers about Section 1115 Medicaid Demonstration Waivers (PDF | 865 KB)
Kaiser Family Foundation. (2011). Five key questions and answers about section 1115 Medicaid demonstration waivers.
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