The Financing of Pharmacy Plus Waivers: Trade Offs Between Expanding Rx Coverage and Global Caps in Medicaid
This issue brief provides an overview of the Section 1115 Medicaid demonstration waivers obtained by six states – Arkansas, Iowa, Michigan, Indiana, New Hampshire and Montana — that are pursuing alternative Medicaid expansions under the Affordable Care Act. It reviews key provisions related to premiums, cost sharing and benefits that have been approved in such waivers by the Centers for Medicare and Medicaid Services (CMS), and also notes those that have been turned down.
This slide shows the current status of state decisions to use Section 1115 waivers to expand Medicaid. A total of 31 states including DC have adopted the ACA Medicaid expansion, including 6 states with ACA 1115 ACA expansion waivers. AZ has a pending waiver application that seeks changes to its expansion. MT and NH’s waivers will take effect on 1/1/16. PA originally expanded through a waiver but subsequently transitioned to a state plan amendment. TN and UT have debated waiver proposals which have not been approved by their state legislatures or submitted to CMS.
The Kaiser Commission on Medicaid and the Uninsured has been monitoring the development of the Pharmacy Plus waiver initiated by the Bush Administration in 2002 and tracking the states that have pending or approved plans. The Commission has developed some materials describing the initiative, examining the financing mechanism, and discussing…
Utah Section 1115 Waiver Fact Sheet (.pdf)
Oregon Section 1115 Waiver
This brief focuses on one subset of “flexibility” issues: the current federal benefits and cost-sharing rules that apply with respect to long-term care.Issue Paper (.pdf)
This issue brief provides an overview of the Independence Plus Initiative, compares core program features with the Cash and Counseling Demonstration program, and discusses several policy issues that arise in the implementation of this initiative.Issue Paper (.pdf)
This policy brief provides an overview of recent Section 1115 waivers and a discussion of key issues. The HIFA initiative, combined with state fiscal pressures, have led to an increase in the number of states seeking Section 1115 waivers. Many of these recent waivers stake out new ground in terms of the scope of changes in coverage that they permit.
This fact sheet compares the two Medicaid premium assistance authorities (state plan option and demonstration waiver) and identifies key beneficiary protections in Medicaid expansion premium assistance programs.
This brief provides an overview of Section 1115 waiver authority, describes major provisions of waivers that extend coverage to childless adults, and identifies key issues and implications of these waivers looking forward to the Affordable Care Act and beyond.
This fact sheet describes Tennessee’s 1115 waiver demonstration project, Insure Tennessee, which expands the State’s Medicaid program under the Affordable Care Act.