Medicaid/CHIP: Waivers - Kaiser Family Foundation

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Medicaid/CHIP: Waivers

Vermont Increases Access and Expands Eligibility to Home and Community-based Services in Medicaid Long-term Care Experiment
This report examines the experience of Vermont’s Choices for Care experiment in delivering long-term services, created through a five-year Medicaid waiver in 2005. The state has seen a shift of people and money toward community settings, but also the return of waiting lists for some populations.

Examining the Role of Section 1115 Waivers in Medicaid and CHIP
Section 1115 waivers have provided important opportunities for states to test innovative coverage approaches in Medicaid and the Children's Health Insurance Program, but have also raised some issues. This brief reviews the experience of Section 1115 Medicaid and CHIP waivers and offers a range of options the Obama administration could consider for future waivers.

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Medicaid Benefits: Online Database -- September 2009
This searchable database, updated to include data through October 2008, houses comprehensive information on Medicaid benefits in the 50 states, the District of Columbia and the U.S. territories. It includes data about 46 services, including whether the benefit is covered, the populations that are eligible to receive various benefits, and the limitations, co-payments and payment rules that apply to the benefits.

Health Care Costs: A Primer -- March 2009
This primer on health care costs examines the rapid growth in the nation’s health care costs since 1970, when the average growth in health spending exceeded the growth of the economy as a whole by an average of 2.5 percentage points. It also examines the impact of health care costs on families, with insurance premiums rising 87% between 2000 and 2006, more than four times the growth in wages.

The Role of Section 1115 Waivers in Medicaid and CHIP: Looking Back and Looking Forward -- March 2009

Section 1115 waivers have provided important opportunities for states to test innovative coverage approaches in Medicaid and the Children's Health Insurance Program, but have also raised some issues. This brief reviews the experience of Section 1115 Medicaid and CHIP waivers and offers a range of options the Obama administration could consider for future waivers.

Medicaid: A Primer 2008 -- December 2008
The primer provides an overview of the basic components of Medicaid, the nation's largest health coverage program, which covers 59 million low-income individuals, including children and families, people with disabilities and the elderly who are also covered by Medicare.

The Medicaid Program at a Glance - UPDATE -- November 2008

This fact sheet provides an overview of the Medicaid program, the populations that it serves and the services that it covers.

Vermont's Choices for Care Medicaid Long-Term Services Waiver: Progress and Challenges As the Program Concluded Its Third Year -- November 2008

This case study report examines the experience of Vermont's Choices for Care experiment in delivering long-term services, created through a five-year Medicaid waiver in 2005. The state has seen a shift of people and money toward community settings, but also the return of waiting lists for some populations.

Health Affairs Article: Florida's Medicaid Reform: Informed Consumer Choice? -- October 2008

Based on the Kaiser Family Foundation's 2006-2007 Survey of Florida Medicaid Beneficiaries, this Health Affairs article finds that many enrollees in the state's reform program lacked key information about their Medicaid changes, leading to reporting difficulties choosing a health plan.

Florida Medicaid Reform Waiver: Early Findings and Current Status -- October 2008

Florida Medicaid Reform Waiver: Early Findings and Current Status

Healthy Indiana Plan: Key Facts and Issues -- June 2008

This fact sheet provides an overview of Indiana's new Medicaid waiver program, the Healthy Indiana Plan, which is the first that allows a state to use Medicaid funds to provide a benefit package modeled after a high-deductible plan and health savings account to previously uninsured adults. This piece examines key components of the plan and identifies key issues to consider.

Choosing Premium Assistance: What Does State Experience Tell Us? -- June 2008

This brief examines six state premium assistance programs (in Florida, Idaho, Illinois, Oregon, Utah, and Virginia) that allow families to choose to receive a subsidy to apply to the purchase of private coverage rather than to receive direct Medicaid or SCHIP coverage.

This searchable database, updated to include data through October 2008, houses comprehensive information on Medicaid benefits in the 50 states, the District of Columbia and the U.S. territories. It includes data about 46 services, including whether the benefit is covered, the populations that are eligible to receive various benefits, and the limitations, co-payments and payment rules that apply to the benefits.

This primer on health care costs examines the rapid growth in the nation’s health care costs since 1970, when the average growth in health spending exceeded the growth of the economy as a whole by an average of 2.5 percentage points. It also examines the impact of health care costs on families, with insurance premiums rising 87% between 2000 and 2006, more than four times the growth in wages.

The primer provides an overview of the basic components of Medicaid, the nation's largest health coverage program, which covers 59 million low-income individuals, including children and families, people with disabilities and the elderly who are also covered by Medicare.

This fact sheet provides an overview of the Medicaid program, the populations that it serves and the services that it covers.

Florida Medicaid Reform Waiver: Early Findings and Current Status

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Medicaid/SCHIP: Waivers

Medicaid and the State Children’s Health Insurance Program (SCHIP) are jointly funded by the federal government and states. States administer their Medicaid and SCHIP programs subject to requirements and options established by federal law. Nationwide, about two thirds of all Medicaid spending is at state option.

Waivers allow states to use federal Medicaid or SCHIP dollars in ways that do not conform to existing federal standards and options. The broadest source of federal waiver authority is section 1115 of the Social Security Act, which allows the Secretary of the U.S. Department of Health and Human Services (HHS) to approve research and demonstration projects that "further the objectives" of the program. Under Section 1115 waivers, states can make broad changes in their Medicaid programs, such as changes in eligibility, benefits, or cost sharing for a group of people that otherwise would not be allowed under federal law. Medicaid section 1115 waivers are not new, but recently HHS has been promoting them through two waiver initiatives--the Health Insurance Flexibility and Accountability (HIFA) initiative and the Pharmacy Plus initiative. HIFA provides states increased flexibility in financing their waivers, including allowing states to reduce coverage for people already eligible for Medicaid to offset the cost of expansions to new groups of people. Under Pharmacy Plus waivers, states can use federal matching funds for the cost of operating prescription drug-only programs for seniors who would not otherwise be eligible for Medicaid. States, generally, must accept a global cap on total federal Medicaid funding as part of the Pharmacy Plus waiver.

Additionally, states can use 1915(c) waivers to provide home and community-based services to individuals who are at risk of institutionalization in a hospital, nursing home, or Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR). Under these waivers, states can provide services not otherwise covered by Medicaid; target specific geographic areas, populations, or conditions; and cap enrollment.