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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- 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.
- October 10, 2019
Pre-Convening Paper: Overview of Medi-Cal’s Behavioral Health System & Necessary Safeguards for an Integrated System
In anticipation of potential proposals to create a more integrated Medi-Cal behavioral health system, this paper provides an overview of the current trifurcated delivery system, evaluates strengths and weaknesses of the current system, and discusses necessary protections and safeguards that a transition to an integrated system must ensure.
- April 1, 2019
National Health Law Program Joins Advocates in Urging Appeals Court to Uphold Constitutionality of Affordable Care Act
Health care advocates including, Families USA, Community Catalyst, National Health Law Program, Center on Budget and Policy Priorities, and Services Union Employees International, filed an amici curiae brief in April in support of California and numerous other state attorneys general who urging the 5th U.S. Circuit Court of Appeals to reverse a lower court ruling the invalidated the entire Affordable Care Act as unconstitutional. The groups' brief concludes that the if the 5th Circuit were to allow the federal district judge's decision to stand that it would subvert the intent of the ACA, to expand health care coverage to low-income individuals and families, and in the process harm tens of millions of people from coast to coast. Because of the ACA, "the drop in the uninsured rate in 2015 was the largest since Medicare was passed and Medicaid first ramped up in the early 1970s. By 2016, the ACA had lowered the number of people without health insurance by more than 20 million people. Affirming the district court's opinion would reverse these gains with devastating consequences to millions of adults and children in the United States. The district court's decision should be reversed," the groups conclude in their friend-of-the-court…