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
The new health reform law includes an expansion of the Medicaid program to provide health care for millions of uninsured individuals, mainly low-income adults. The Supreme Court ruled in June that states can choose whether to expand their Medicaid programs. If Tennessee chooses to expand its Medicaid program, the federal government will pay all of the cost for the first three years, with the federal payments reducing to 90 percent by 2020. This is a great deal for Tennessee. The expansion would bring billions of federal dollars into Tennessee?s economy. It would also provide essential health coverage for tens of thousands of uninsured veterans and their families in Tennessee who struggle to get the health care they need. ? 35,000 veterans in Tennessee do not have health insurance. In addition, 20,000 family members of veterans do not have health insurance. ? Uninsured veterans suffer from significant health problems. One-third of uninsured veterans have at least one chronic health condition, 15.3 percent are in fair or poor health, and 15.9 percent are limited because of physical, mental, or emotions problems. ? Uninsured veterans and their families struggle to get the…
- July 23, 2013
The U.S. Supreme Court ruled in June that the Affordable Care Act (ACA) permits, rather than requires, states to expand Medicaid eligibility up to 138 percent of the federal poverty line (FPL). Now, Tennessee must choose whether to expand Medicaid. If Tennessee chooses not to expand Medicaid, it will cost some Tennessee businesses hundreds of thousands of dollars in additional federal taxes after 2014. Here?s how. The ACA calls for the creation of a competitive health insurance marketplace (sometimes called an ?exchange?) in every state by 2014. The exchange is required to have an easy-to-use website that allows consumers to make applesto-apples comparisons when they shop for health insurance. In the exchange, certain consumers with incomes between 100 and 400 percent of the federal poverty level will be eligible for premium tax credits to help them pay their insurance premiums. The ACA does not require businesses to provide health insurance to their workers. Starting in 2014, however, employers with at least 50 full-time employees will face tax penalties if they do not offer affordable insurance to their employees and one or more full-time employees receive a premium tax credit on the exchange. The ACA was designed with the expectation…
- July 23, 2013
The Supreme Court ruled in June that the new health reform law permits, rather than requires, states to expand their Medicaid programs to cover people with incomes up to 138 percent of the federal poverty line. Now, Tennessee must choose whether to expand Medicaid (TennCare). Some have argued that Medicaid expansion is too expensive. In fact, Medicaid expansion will not significantly increase costs for the state and will generate significant new tax revenues that will offset much or all of any additional costs through 2020. Tennessee requires all health maintenance organizations (HMOs) doing business in Tennessee to pay a 5.5% tax on all premium dollars collected from or on behalf of enrollees. Because all Medicaid enrollees in Tennessee are enrolled in HMOs (generally called Managed Care Organizations, or MCOs, in the TennCare context), Tennessee receives tax payments from TennCare MCOs from the premiums they collect on behalf of TennCare enrollees. If Tennessee decides to expand Medicaid, the federal government will pick up all of the cost of the expansion for the first three years (2014-2016). Depending on the number of newly eligible individuals who enroll in the first three years, this could bring between $1.5…