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Insurance Coverage: Waivers

Tennessee 1115 Waiver Application

On September 17th, 2019, Tennessee released its proposal to implement a black grant for Tennessee’s Medicaid program, otherwise known as TennCare.  This 1115 waiver, referred to as “Amendment 42,” would convert the federal share of the state’s Medicaid funding for most services into a block grant.

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Insurance Coverage: Waivers

Montana 1115 Waiver Application Summary

Montana submitted a new 1115 waiver application to CMS on August 30, 2019. The waiver is pending approval.

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Utah Medicaid Waivers

CMS has approved Utah’s 1115 waiver, implementing a “bridge plan” while the state submits additional waivers.

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Insurance Coverage: Waivers

New York 1115 Waiver Application Summary

On August 9, 2019, New York announced it will submit a Section 1115 Medicaid Demonstration waiver application to CMS to provide Medicaid services to certain incarcerated individuals about to be released from county jails and New York State prisons.

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CMS Approves Colorado and North Dakota 1332 Waiver Applications

On July 31, 2019, the Centers for Medicare and Medicaid Services (CMS) approved Section 1332 waiver applications for Colorado and North Dakota to implement state reinsurance programs. Below is a summary of the waivers.

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Insurance Coverage: Waivers

South Carolina 1115 Waiver Application Summary

On May 8, 2019, South Carolina submitted a new 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS). The waiver includes work requirements, expands coverage for children, pregnant women and parents, and expands coverage for certain individuals with substance use disorders, who are chronically homeless or who are involved in the justice…

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Insurance Coverage: Waivers

Utah Per Capita Cap 1115 Waiver Summary

On May 31, 2019, Utah released its 1115 waiver proposal, “Per Capita Cap.” This waiver requests authority to implement the provisions of Senate Bill 96 “Medicaid Expansion Adjustments”, which passed during the 2019 Utah legislative session.  Provisions of the waiver include implementing a per capita cap, seeking enhanced Federal Medical Assistance Percentages (FMAP) for the…

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Insurance Coverage: Waivers

Utah Medicaid 1115 Waiver Summary

On June 22, 2018, Utah submitted an 1115 waiver amendment to CMS seeking to implement a partial and capped Medicaid expansion, as well as Medicaid work requirements for certain populations. Following that waiver amendment, on February 6, 2019, Utah submitted an additional 1115 waiver amendment lifting the Medicaid Institution for Mental Disease (IMD) exclusion for…

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Insurance Coverage: Waivers

Kentucky and Arkansas Work Requirements Blocked

U.S. District Judge James Boasberg ruled that the federal government failed to justify adding work requirements to Kentucky and Arkansas’ Medicaid program. Both decisions remand the Arkansas and Kentucky waivers back to HHS.

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Insurance Coverage: Waivers

Ohio Section 1115 Waiver Approval

On March 15, 2019, CMS approved Ohio’s Medicaid 1115 waiver, allowing the state to implement work requirements for certain Medicaid recipients.

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Insurance Coverage: Waivers

Section 1115 Guidance

On March 14th CMS published tools and guidance for states on how to monitor and evaluate 1115 waivers that implement work requirements, require monthly premiums, implement premium assistance programs, waive retroactive eligibility, or implement non-eligibility periods for failing to meet requirements. Additionally, CMS published monitoring and evaluation guidance and tools for states that are implementing…

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