Waivers
Section 1115 of the Social Security Act establishes authority for the Secretary of Health and Human Services (HHS) to waive certain provisions of the Medicaid and CHIP statutes for a state to establish an “experimental, pilot or demonstration” project that promotes the objectives of the program. Such demonstrations are intended to test and learn about new approaches to program design and administration. States have obtained Section 1115 waivers that make broad changes in Medicaid eligibility, benefits, cost sharing, and delivery and payment of care.
Georgia Pathways Implementation: The Glass is 99.6% Empty
On October 5, 2023, CMS certified as complete Georgia’s implementation plan (the implementation plan itself starts on page 50) for phase one of its “Pathways to Coverage” section 1115 demonstration that the state had already started implementing more than 3 months earlier, on July 1, 2023. Yes, you read that right. And no, it doesn’t […]
Updated List of Flexibilities Highlight Variety of Approaches States Are Taking to Promote Continuity of Coverage During the Unwinding
To meet the unprecedented moment of the unwinding of the Medicaid continuous coverage protection, states have implemented a range of innovative policies to make the renewal process smoother for enrollees as well as state eligibility workers. One tool that states have increasingly used is Section 1902(e)(14)(A) waivers, or “e14s,” which we have written about previously […]
CMS Makes the Right Call on Utah’s Medicaid Waiver: Where Do Things Stand on Postpartum Coverage?
In a little-noticed but important action, CMS recently notified the Utah Medicaid agency that it should proceed with extending postpartum coverage from 60 days to 12 months under the state plan amendment (SPA) option rather than continuing to pursue its Section 1115 waiver request. At first blush, this seems like a distinction only the most […]
The Biden Administration CMS Unwinds the Tennessee “Block Grant”
Two and a half years ago, on January 8, 2021, with considerable fanfare, the Trump administration CMS announced the approval of a Medicaid “aggregate cap waiver” for Tennessee. The Governor was more forthcoming, trumpeting the state’s receipt of a “block grant waiver.” You say “aggregate cap,” I say “block grant,” let’s call the whole thing […]
An Analysis of Georgia’s Section 1115 Medicaid Pathways to Coverage Program
Download Full Report In July 2023, Georgia will begin enrollment into its new Medicaid Pathways to Coverage (“Pathways”) program, with coverage expected to begin in September 2023. The program would offer coverage to a subset of low-income adults who meet a work reporting requirement and, depending on their income, pay a monthly premium. Georgia will […]
Low-Income Parents at Significant Risk Under the House-Passed Medicaid Work Reporting Requirements in Debt Ceiling Bill
We’ve been closely reading Section 321 of the House-passed debt ceiling bill which would establish a pernicious new maze of red tape to trip people up and cause them to lose Medicaid coverage. While posing as a “work requirement”, this is really a plan to make people jump through more hoops in order to keep […]