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State care providers occasionally want to use Medicaid for programs that don’t fit requirements of the Social Security Act.

What do do?

Frequently, states turn to Section 1115 of the Social Security Act. Section 1115 lets a state seek a waiver of limiting requirements.

States have worked through Section 1115 to waive …
• patient freedom of choice
• limited length of patient lock-in to managed care providers
• 90-day retroactive Medicaid eligibility
• service comparability
• limitations on groups of Medicaid eligibles
• FQHC services as mandatory Medicaid services
• and PPS reimbursement to FQHCs for services to new groups of eligibles created under the waiver.

Centers for Medicare and Medicaid Services (CMS) waiver page, which contains state-by-state information on current and pending waivers

 

THE FOLLOWING DOCUMENTS PROVIDE DETAILED EXAMINATION 1115 WAIVER:

12-01-2007		1115 Waiver and State Plan Amendment Matrix - State Policy Report #19 (December 2007) (317kb)
12-01-2007		1115 Waiver Regulations (954kb)
12-01-2007		Summary of legal aspects (71kb)

THE FOLLOWING DOCUMENTS EXAMINE 1115 WAIVERS BY SPECIFIC STATE:

State Concept Papers

01-01-2004		Connecticut (2078kb)
06-01-2005		Georgia (658kb)
10-01-2006		Louisiana (768kb)
12-01-2005		Nebraska (539kb)
11-01-2004		New Hampshire (945kb)
06-01-2006		Oklahoma (549kb)
09-01-2006		South Carolina (360kb)

Pending Applications:

06-01-2006		Montana (386kb)
06-01-2005		Michigan (462kb)

New Approved Waivers

03-01-2006		Arkansas (159kb)
09-01-2005		California (103kb)
10-01-2005		Florida (134kb)
01-01-2006		Hawaii (1386kb)
07-01-2005		Iowa (1556kb)
10-01-2005		Kentucky Partnership (201kb)
01-01-2005		Massachusetts (1008kb)
10-01-2006		New York (398kb)
10-01-2005		Oklahoma (52kb)
01-01-2002		Oregon (718kb)
06-01-2005		Tennessee (736kb)
09-01-2005		Vermont (292kb)

Approved State Plan Amendments:

06-06-2008		Maine (7kb)
06-06-2008		Missouri (21kb)
06-06-2008		Pennsylvania (11kb)
06-06-2008		South Carolina (17kb)
06-06-2008		Virginia (20kb)
06-01-2005		West Virginia (235kb)
06-06-2008		Wisconsin (72kb)

Benchmark

06-06-2008		Idaho (26kb)
06-06-2008		Idaho (105kb)
06-06-2008		Kansas (623kb)
06-06-2008		Kentucky (978kb)

Archives

12-07-2007		Emerging Issues in Medicaid and SCHIP #1: Tennessee’s New Definition of “Medically Necessary” (370kb)
07-01-2005		Emerging Issues in Medicaid and SCHIP #2: Medicaid Reform: Privatization and Health Savings Accounts (169kb)