Waiver Tool Box

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About Waivers

The Bush Administration encouraged states to use the Section 1115 waiver process to make changes in their Medicaid and CHIP programs. Some of these changes will jeopardize access to vital health care services for America's most vulnerable people. This Web page is designed to help you keep track of what's going on in your state and in other states around the country. The information has been produced by Families USA and by other national and state advocacy groups.

Note to advocates: Don't worry about trying to figure out whether a waiver is a "HIFA" or a Section 1115 waiver—the differences don't really matter when trying to analyze whether a waiver is "good" or "bad."  

Also, many states abandoned their plans to implement Medicaid waivers when the Deficit Reduction Act (DRA) was signed into law in February 2006. The DRA allows states to make changes that previously required a waiver through a simpler mechanism, state plan amendments. So far, CMS has approved DRA-related state plan amendments for seven states: Idaho, Kansas, Kentucky, South Carolina, Virginia, Washington, and West Virginia. Information about these states’ state plan amendments can be found here.

Background

• Table: Status and Selected Features of State Medicaid Section 1115 Waiver Applications and Concept Papers as of August 25, 2006
• Premium Assistance: The Privatization of Medicaid
• Cost-Sharing in Medicaid: It's Not about "Skin in the Game"—It's about Lives on the Line
• Preserving Medicaid in Tough Times: An Action Kit for State Advocates
• Frequently Asked Questions (FAQs) (April 2006) 

Information from the Centers for Medicare and Medicaid Services (CMS)

• Research and Demonstration Projects—Section 1115
• Medicaid Waivers and Demonstrations List
• Evaluations of Medicaid Demonstrations 
• Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative Overview 
• Guidelines for States Interested in Applying for a Health Insurance Flexibility and Accountability (HIFA) Demonstration 

More Resources

• Rhode Island has submitted its Global Consumer Choice Compact Waiver to CMS for approval. The waiver asks for the authority to become the first state “to use global budgeting as a financing mechanism for all Medicaid populations and services.” The most significant changes are in long-term care. The National Senior Citizens Law Center has written an analysis of the proposed long-term care changes, The Long-Term Care Proposals in Rhode Island’s Global Consumer Compact Waiver. Issues that are raised in the paper include the fact that Rhode Island has not availed itself of important long-term care opportunities that do not require waivers, that it has only recently implemented other programs that may produce favorable results, and that it does not appear to be fully embracing the purpose of Vermont’s Choices for Care program, the central feature of which Rhode Island has borrowed for its own proposal.

• A letter from members of the Senate Finance Committee urges Secretary Leavitt to make the process for states that are applying for Section 1115 waivers more transparent and to give more opportunity for public input. Since waivers may result in far-reaching changes to state Medicaid or CHIP programs that significantly affect who can be covered and what care they get, it is imperative that CMS ensure a thorough and transparent review process that allows for input of stakeholders at both the state and federal level. The Senators' letter echoes concerns laid out in a July 2007 GAO letter. (June 2008)
• National Health Law Program's (NHeLP) Waiver Watch  
• Kaiser Commission on Medicaid and the Uninsured
  • Medicaid/SCHIP Waivers—general Web page
  • New Directions for Medicaid Section 1115 Waivers: Policy Implications of Recent Waiver Activity
• Georgetown University Health Policy Institute, Center for Children and Families

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