Section 1115 waivers: States’ Recent Use of This Tool to Change the Medicaid Landscape

Adams C
Publication Year: 2018
Patient Need Addressed: Behavioral health
Population Focus: Medicaid beneficiaries
Demographic Group: Adult
Type of Literature: Grey


Insights Results

Overview of article/programs

  • This article provides an overview of Section 1115 focuses and implications
  • Since January 2018, South Dakota, Illinois Louisiana and New Hampshire have had new 1115 waivers approved by CMS while Alaska’s is still pending approval
  • South Dakota’s first 1115 waiver provides full Medicaid coverage for former foster care youth up to age 26 who were residents of another state or territory on the date of aging out of foster care
  • The new waivers from Louisiana, New Hampshire, Illinois and Alaska target behavioral health and substance use disorder treatment in the midst of the opioid epidemic. For instance, the Healthy Louisiana Substance Use Disorder and the New Hampshire Substance Use Disorder Treatment and Recovery Access Section 1115 waivers provide opioid and other substance use disorder services to individuals temporarily residing in Institutions for Mental Diseases (IMDs)
  • Illinois’ waiver will implement 10 pilot programs for physical and behavioral health integration and substance use disorder treatment through inpatient and residential services, case management, home visiting, peer support, crisis intervention, and community and employment-based initiatives
  • If approved, Alaska’s waiver will create an integrated behavioral health system for beneficiaries with severe mental illness and/or substance use disorders that will include efforts to provide early interventions, community-based outpatient services, inpatient residential treatment and peer support programs
  • Multiple states including Arkansas, Indiana, and Mississippi, received approval from CMS to extend their existing waiver programs. The waivers were focused on a variety of topics including coverage for disabled children and premiums for the expansion adult population. Mississippi received approval from CMS for the first 10-year extension ever granted for its family planning waiver, which provides family planning services and supplies to eligible women and men. Missouri withdrew its waiver request to create a limited benefit package for uninsured young adults with behavioral health crises. Iowa ended its Family Planning Network waiver program, which provided access to family planning services for adults under the age of 50 with incomes up to 300% of the federal poverty level (FPL) otherwise ineligible for Medicaid. A state family planning program was created in its place. The authority to provide coverage for aged and disabled individuals with incomes at or below 88% FPL in one Florida waiver was transitioned to the Florida Managed Medical Assistance (MMA) waiver, which is the state’s managed care model

    Key takeaways/implications

    • It’s important to also consider the impact of Medicaid work requirements on access to chare and its impact on overall Medicaid programs. Specifically, the implementation of work requirements have the potential to push eligible adults already receiving Medicaid off of the program as well as prevent new adults from enrolling in the program. The verification requirements may also discourage eligible individuals from continuing their Medicaid enrollment. There are multiple barriers to just reporting work or other activity such as knowledge of and access to technology