Section 1115 Medicaid waivers allow states to explore new options for providing health coverage to persons who would otherwise not be eligible and allow states to examine innovative ways to deliver care by waiving certain requirements of the Medicaid Act.
While waivers can be important tools that can help states respond to the needs of low-income individuals, they also present concerns for health advocates working to protect the rights of Medicaid enrollees and promote transparency in state waiver processes.
Sec. 1115 of the Social Security Act allows the Secretary of Health and Human Services to waive some requirements of the Medicaid Act so that states can test novel approaches to improving medical assistance for low-income people.
Under the current administration, several states are seeking waivers to impose harmful cuts and restrictions. The first set of harmful waivers have been approved for Kentucky and Arkansas, with a number of states seeking to enact similar changes to Medicaid. Learn more about Medicaid waivers and how the National Health Law Program is combating the Trump administration’s illegal use of waivers to weaken Medicaid.
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- December 18, 2019
Advocate Fact Sheet: Evaluating Mental Health Plans’ Provision of Medi-Cal Specialty Mental Health Services
Medi-Cal beneficiaries in California receive mental health services through two separate managed care systems. Medi-Cal Managed Care Plans (MCPs) are responsible for providing non-specialty mental health services and County Mental Health Plans (MHPs) are responsible for providing specialty mental health services (SMHS). This bifurcated system often serves as a barrier for beneficiaries seeking to access mental health services, because it leads to enrollee confusion and its success depends on effective coordination between the plans, which is oftentimes non-existent. This fact sheet focuses on the provision and delivery of SMHS and provides an analysis of the tools and processes that are available to hold MHPs accountable to serve Medi-Cal beneficiaries.
- December 16, 2019
Sec. 1115 of the Social Security Act allows the Secretary of HHS to waive some requirements of the Medicaid Act so that states can test novel approaches to improving medical assistance for low-income people. While historically states have proposed waivers that did indeed propose innovative approaches to improve Medicaid and expand coverage, now, at HHS’s urging, several states are seeking waivers to impose harmful cuts and restrictions. The first set of harmful waivers have been approved for Kentucky, with a number of state’s poised to enact similar changes to Medicaid. This chart provides an overview of the harmful waiver provisions that have been proposed to-date. (Chart updated as of December 16, 2019)
- December 6, 2019
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Utah's proposed project, which would impose a number of unlawful conditions on coverage and access to care. Utah requested a number of restrictions, including: capping enrollment in the expansion population; imposing work requirements; charging premiums (and terminating coverage and imposing a lockout penalty for failure to pay); charging an amount higher than otherwise permitted for non-emergency use of the emergency room; eliminating hospital presumptive eligibility; imposing a lockout penalty for an "intentional program violation;" eliminating EPSDT for people ages 19 and 20; cutting services for parents; and ignoring various managed care protections. The comments explain why the proposed project does not comply with the requirements of § 1115 of the Social Security Act.