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Key Themes From Delivery System Reform Incentive Payment (DSRIP) Waivers in 4 States

Building on an earlier brief that provided an overview of the components of DSRIP waivers, this analysis relied upon interviews with stakeholders to identify emerging trends and themes from DSRIP waivers in four states – California, Massachusetts, New York and Texas. It highlights that DSRIP waivers are spurring major change in relationships among providers; allowing providers to launch new initiatives aimed at improving care and reducing costs; and fostering a stronger focus on the social service needs of Medicaid beneficiaries. At the same time, the rapid pace of implementation is straining the ability of stakeholders to keep pace, including consumer advocates who are hard-pressed to track and respond to the DSRIP-driven changes that are fundamentally re-shaping the way that care is delivered to Medicaid beneficiaries.

Medicaid Expansion in New Hampshire

This fact sheet provides a summary of the approved waiver in New Hampshire. New Hampshire has already implemented the ACA Medicaid expansion, but state legislation required the state to submit a waiver to implement mandatory Qualified Health Plan (QHP) premium assistance beginning in January 2016.

The ACA and Medicaid Expansion Waivers

This brief focuses on Section 1115 Medicaid demonstration waivers related to implementation of the ACA Medicaid expansion (eligible for ACA enhanced matching funds) or other coverage (not eligible for ACA enhanced matching funds). To date, the Centers for Medicare and Medicaid Services (CMS) has approved waivers to implement the Medicaid expansion in five states: Arkansas, Iowa, Michigan, Pennsylvania and most recently Indiana. In addition, Pennsylvania has a waiver proposal. In addition, New Hampshire has a proposal pending with CMS, and Governors in both Tennessee and Utah have been negotiating plans with CMS, but these plans also need to be approved by the state legislature.

An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion

The ACA Medicaid expansion has garnered different responses from statelawmakers – Democratics and Republicans as well as governors and legislatures. While it does not cover how every state has enacted the ACA Medicaid expansion, this fact sheet highlights some of the different actions state lawmakers have taken in response to the ACA Medicaid expansion.

Medicaid Expansion in Iowa

This fact sheet summarizes key features of IA’s Medicaid expansion waivers.

Medicaid Expansion in Indiana

This fact sheet summarizes key elements of Indiana’s Section 1115 Medicaid expansion waiver, HIP 2.0.

Proposed Medicaid Expansion in Tennessee

This fact sheet describes Tennessee’s 1115 waiver demonstration project, Insure Tennessee, which expands the State’s Medicaid program under the Affordable Care Act.

Proposed Medicaid Expansion in Utah

This fact sheet provides a summary of the proposal to expand Medicaid in Utah. This has not been officially submitted to CMS and needs state legislative approval before it could be implemented.