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An OPEN MINDS Market Intelligence Report

This Market Intelligence Report from the OPEN MINDS team discusses the role of Medicaid waivers. Waivers give states the flexibility to make changes in how they operate their Medicaid programs by “waiving” certain federal requirements. States may request approval (“waiver”) by the Centers for Medicare and Medicaid (CMS) of provisions in Section 1902 of the Social Security Act (SSA), but not other sections of the law pertaining to Medicaid. Section 1902 covers Medicaid state plans and details what states must include in their Medicaid programs and how they must function.

There are four types of waivers available to states seeking to make changes to their Medicaid system. The four types are listed below:
Section 1115 Research & Demonstration Projects – tests broader reform initiatives for the finance and delivery of Medicaid and CHIP services
Section 1915(b) Managed Care Waivers – enrolls beneficiaries in managed care delivery systems
Section 1915(c) Home and Community-Based Services Waivers – supports a shift in the delivery of long-term care services from institutional settings to in home and community settings
Concurrent Section 1915(b) and 1915(c) Waivers – provides a continuum of services to the elderly and people with disabilities within limits of federal requirements for both programs

There are currently 406 state Medicaid waivers approved by the federal Centers for Medicare & Medicaid Services (CMS). The majority are section 1915(c) Home and Community-Based Services (HCBS) waivers – HCBS waivers account for over 72% of the current total of waivers.

This report answers a number of questions on Medicaid waivers and the states utilizing them:

  1. What are the different types of CMS waivers and what populations are covered in each kind of waiver?
  2. How do state Medicaid waivers differ from State Plan Amendments (SPAs)?
  3. How many state waivers are currently in place and how many are pending?
  4. What waivers are currently active in each state, and what populations do they serve?

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