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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- July 23, 2013
Civil Action No. 93-452 (GK) OSCAR SALAZAR, et al., Plaintiffs, v. DISTRICT OF COLUMBIA, et al., Defendants. MEMORANDUM OPINION Upon consideration of the Motion of Non-Parties HSCSN and MHS (?Non-Parties?) to Reconsider the Court?s Order Granting Plaintiff?s Motion to Compel and for Stay Pending Reconsideration, and the Motion for Protective Order of those same Non-Parties, the Oppositions, the Replies, and the lengthy history of this case, the Court concludes that the Motion for Reconsideration is granted in part and denied in part, and the Motion for Protective Order is granted in part and denied in part. Plaintiffs and Non-Parties have been battling over the discoveryissue raised in these Motions for a long period of time. By now, the issue has narrowed down to whether a Protective Order should be granted to Non-Parties and, if so, how restrictive it should be.1 On December 19, 2006, the Court granted in part and denied in part Plaintiffs? Motion for Leave to Conduct Limited Discovery Concerning Compliance with Paragraph 36 of the Settlement Order . Specifically, Plaintiffs were allowed to obtain discovery of ?the general polices and procedures? of the Non-Parties for authorizing, re-authorizing, and terminating certain health…
- July 23, 2013
UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA OSCAR SALAZAR, et al., Plaintiffs, : v. DISTRICT OF COLUMBIA, et al., Defendants. : ORDER Upon consideration of the Motion of Non-Parties HSCSN and MHS to Reconsider the Court?s Order grantingPlaintiff?s Motion to Compel and to StayPending Reconsideration and Non-Parties? Motion for Protective Order, the Oppositions, the Replies, and the lengthy history of this case, it is hereby ORDERED, that the Motion for Reconsideration is granted in part and denied in part; and it is further ORDERED, that the Motion for Protective Order is granted in part and denied in part; and it is further ORDERED, that Non-Party HSCSN and MHS, and/or the Defendants, shall, within 10 business days from the date of this Order, provide to Plaintiffs the InterQual® Clinical Decision Support Criteria (?the Criteria?); and it is further ORDERED, that Plaintiffs shall not publish the Criteria in any publicly accessible form, such as books, magazines, professional journals, the Internet, etc.; and it is further ORDERED, that Plaintiffs? counsel shall exercise reasonable care to avoid anypublication of the Criteria in the fashion…
- July 23, 2013
States? use of managed care has expanded steadily over the last 30 years. The Kaiser Commission on Medicaid and the Uninsured recently surveyed Medicaid managed care in the 50 states and found that, overall, 30 of the 48 states with comprehensive managed care programs are contracting with risk-based managed care organizations (MCOs). See Kaiser Comm?n on Medicaid and the Uninsured, A Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-state Survey 2 (Sept. 2011) (also reporting 31 states operated primary care case management systems). When MCOs aggressively entered the Medicaid market 30 years ago, they promised budget predictability to states and a medical home to Medicaid beneficiaries. And while the former has been achieved to some extent, the latter has not. More than two-thirds of responding states with MCOs report that enrolled Medicaid beneficiaries experience access problems. Id. at 3. The Role of HEDIS The Health Effectiveness Data and Information Set (HEDIS) is a group of performance measures owned by the National Committee for Quality Assurance (NCQA). Some state Medicaid programs use HEDIS to measure MCO performance. D.C. Snapshot More…