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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- November 4, 2014
New York is one of several states working to better integrate care and services for individuals dually eligible for Medicare and Medicaid through a duals demonstration. In addition to integrating care, New York is working to integrate the Medicare and Medicaid appeals processes for individuals participating in its duals demonstration. This issue brief analyzes New York's integrated appeals process and examines the effects of integration on enrollees' due process rights.
- July 23, 2013
UNITED STATES DISTRICT COURT WESTERN DISTRICT OF NEW YORK __________________________________________ HARRY DAVIS, et al., Plaintiffs -vs- NIRAV SHAH, individually and in his official capacity as Commissioner of the New York State Department of Health, Defendant __________________________________________ APPEARANCES For Plaintiffs: Bryan D. Hetherington, Esq. Geoffrey A. Hale, Esq. Jonathan Feldman, Esq. Empire Justice Center One West Main Street, Suite 200 Rochester, New York 14614 Martha Jane Perkins, Esq. Sarah Jane Somers, Esq. National Health Law Program 101 E. Weaver Street, Suite G-7 Carrboro, North Carolina 27510 For Defendant: J. Richard Benitez, Esq. Office of the New York State Attorney General 144 Exchange Boulevard, Suite 200 Rochester, New York 14614 INTRODUCTION This is an action brought by Medicaid recipients to challenge New York State?s decision to provide Medicaid payment for prescription footwear and compression stockings for certain medical conditions but not others. Specifically, Plaintiffs challenge New York State Social Services Law § 365-a(2)(g)(iii), which provides Medicaid payment only for prescription footwear ? used as an integral part of a lower limb orthotic appliance, as part of a…
- July 23, 2013
January 23, 2007 Dear Pharmacy Provider: As of February 1, 2007, the emergency contraceptive drug, Plan B, can be dispensed as an over-the-counter (OTC) drug without a fiscal order to women 18 years of age and older. The dispensing of Plan B to women under 18 years of age still requires a prescription. Plan B will be limited to 6 courses of therapy in any 12 month period for any Plan B prescription and non-prescription combination. In order to receive Medicaid payment for Plan B without a fiscal order, pharmacists must follow these Medicaid requirements: Verify the age of the Medicaid recipient (FDA requirement) Use the following MMIS prescriber ID# for Plan B dispensed without a fiscal order: 02833383 This MMIS ID# can only be used when billing for OTC Plan B drugs dispensed without a fiscal order. If you have any questions on this policy, you may contact the Bureau of Policy Development and Agency Relations at (518) 473-2160. Sincerely, Deborah Bachrach Medicaid Director Deputy Commissioner Office of Health Insurance Programs