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.
- October 22, 2019
Helping Families Obtain Durable Medical Equipment and Supplies Through The California Children’s Services (CCS) Program
This advocates issue brief provides the framework for accessing Durable Medical Equipment and medical supplies through the California Children's Services (CCS) program, including: a program overview, existing guidance on how to access services in Whole Child Model and non-Whole Child Model counties, considerations when children have Medi-Cal and/or other health coverage, and consumer rights.
- October 21, 2019
Internal and External Review: Medi-Cal Managed Care Plans Managed Care in California Series Issue No. 4 (Revised October, 2019)
Federal and state law and the state and federal Constitutions require that enrollees in Medi-Cal managed care plans receive notice, and grievance and appeal rights when they are denied access to medically necessary services. Frequently, however, enrollees fail to receive the required notice, get an inadequate notice, or do not understand their right to appeal the plan’s decision. This issue brief will provide an overview of the rules and processes for notice, grievances, and appeals that apply to Medi-Cal plans.