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
Key Findings Cost shifting imposes a significant ?hidden health care tax? on privately insured Missourians. Medical care provided with reduced or no compensation is a significant driver of cost shifting. Cost shifting occurs when health care providers are reimbursed at a higher rate for privately insured patients in order to cover the losses incurred by treating Medicare and Medicaid patients and uninsured or underinsured patients who default on payments for services previously rendered in good faith. Missouri hospitals provided $10.5 billion in uncompensated care throughout the past decade. growth in uncompensated care exceeded 90 percent between 2002 and 2011. Per capita growth in uncompensated care exceeded 80 percent. During the same period in Missouri, net earnings per capita increased nearly $400 per month. Adjusting for inflation brought the real gain in net earnings for Missourians to just $23 per month. After accounting for cost shifting attributable to uncompensated care, annual net earnings for the average privately insured Missourian was $370 lower in 2011 compared to 2002. Hospital uncompensated care in Missouri was $1.3 billion in 2011. it is projected to grow to more than $3.5 billion per year by 2019. Medicaid reform would offset…
- July 23, 2013
Eighth Circuit opinion finding denial of coverage by Missouri Medicaid of medical equipment and supplies illegal.
- July 23, 2013
This Q&A describes the decision and implications of the Eight Circuit decision in Lankford v. Sherman, a challenge to a Missouri regulation limiting coverage of durable medical equipment in the Medicaid program.