In July, the Centers for Medicare and Medicaid Services (CMS) approved seven new Reentry Section 1115 Demonstrations in Illinois, Kentucky, New Hampshire, New Mexico, Oregon, Utah, and Vermont. These states join California,...more
Summary On June 17, 2024, the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid Services (CMS) released a notice of funding opportunity (NOFO) for Innovation in Behavioral Health...more
Summary-
On January 18, 2024, the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid Services (CMS) announced Innovations in Behavioral Health (IBH), a new eight-year model focused...more
On December 1, 2023, North Carolina will become the 40th state to implement Medicaid expansion under the Affordable Care Act (ACA), extending Medicaid eligibility to more than 600,000 adults with incomes up to 138% of the...more
Editor’s Note: 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. Recently, the Centers...more
The behavioral health workforce in Massachusetts is in crisis. The COVID-19 pandemic has increased the prevalence of behavioral health issues and demand for services, exposing and aggravating the vulnerabilities of...more
On June 28, 2022, the Centers for Medicare & Medicaid Services (CMS) approved a five-and-a-half-year renewal of Vermont’s Global Commitment to Health (Global Commitment) Section 1115 demonstration. The Global Commitment...more
Section 1115 of the Social Security Act permits states to waive certain Medicaid statutory requirements through demonstration projects that advance state policy priorities and test innovations in their Medicaid programs....more
Four months after the Centers for Medicare & Medicaid Services (CMS) offered state Medicaid programs a new COVID-19 Section 1115 waiver opportunity, five of at least 20 applying states have received approval of their waiver...more
8/13/2020
/ 1115 Waivers ,
1135 Waivers ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Disaster Relief Fund ,
HCBS Waivers ,
Health Care Providers ,
Medicaid ,
Public Health Emergency ,
Regulatory Requirements ,
State Medicaid Programs
On May 11, 2020, New York State submitted a COVID-19 1115 waiver application to the Centers for Medicare & Medicaid Services (CMS), leveraging the opportunity to respond to the COVID-19 public health emergency (PHE) as...more
On November 6, 2019, the Centers for Medicare and Medicaid Services (CMS) approved Washington, DC’s Behavioral Health Transformation Demonstration, which waives the institution for mental diseases (IMD) exclusion for...more
On May 31, 2019, Utah released a draft Section 1115 waiver application, the Per Capita Cap Demonstration, for public comment. The proposal seeks to create a new Section 1115 demonstration that, if granted, would break new...more
Issue 1 -
The Issue -
Medicaid is woven into the fabric of states’ health care systems and economies: it covers one in five Americans; is the single largest insurer in every state; and is the largest source of funding...more
During the first half of 2018, the Centers for Medicare & Medicaid Services (CMS) granted four states—Arkansas, Indiana, Kentucky and New Hampshire—Section 1115 waivers permitting them to condition Medicaid coverage for...more
In January 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance to states as to the circumstances under which CMS would approve Section 1115 demonstration waivers making work/community engagement (CE)...more
Medicaid’s Critical Role in Addressing the Opioid Crisis -
As the opioid crisis in the United States continues to deepen—with opioid overdoses claiming 42,000 lives in 2016—policymakers, providers, advocates and other...more
Medicaid has entered a period of volatile change, unprecedented in its 51-year history.
With 74 million members nationwide,1 Medicaid provides health coverage to more than one in four Americans, ensuring access to...more
On October 6, the Centers for Medicare & Medicaid Services (CMS) approved West Virginia’s “Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorders” Section 1115 demonstration. West Virginia’s waiver,...more
Massachusetts Waiver Amendment Requests Partial Expansion and Closed Formulary -
On September 8, 2017, Massachusetts submitted a waiver amendment request to the Centers for Medicare & Medicaid Services (CMS) to modify its...more
Indiana is seeking a three-year extension of its Healthy Indiana Plan (HIP) 2.0 Section 1115 demonstration. Through HIP 2.0, which the Centers for Medicare and Medicaid Services (CMS) approved in January 2015, Indiana...more
On May 12, 2017, Massachusetts released for public comment a proposed amendment to its MassHealth Section 1115 demonstration. MassHealth is a comprehensive demonstration that applies to the State’s entire Medicaid population....more
On April 25, 2017, the Maine Department of Health and Human Services released for public comment a draft Section 1115 waiver application to implement new eligibility and coverage requirements for MaineCare, the State’s...more
5/2/2017
/ 1115 Waivers ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Fee-for-Service ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicaid Work Requirements ,
Premiums
On April 19, 2017, Wisconsin released for public comment a proposed amendment to its BadgerCare Reform Section 1115 demonstration. BadgerCare Reform currently provides coverage to approximately 150,000 childless adults ages...more
4/24/2017
/ 1115 Waivers ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Drug Testing ,
Drug Treatment ,
Eligibility ,
Enrollment ,
Federal Poverty Line ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicaid Work Requirements ,
Mental Illness ,
Proposed Amendments ,
Trump Administration ,
Waivers
Editor’s Note: The United States is in the throes of a rapidly worsening opioid epidemic. The crisis is far-reaching: As of 2014, 1.9 million Americans had an opioid use disorder involving prescription medication, and an...more
Editor's note: Medicaid is the largest healthcare payer in virtually every state. States are increasingly leveraging that position to drive payment and delivery system reform efforts. One powerful tool to enable...more