Medicaid Waivers

This letter provides guidance to states on how the long-term services and supports-related rules, including the estate recovery rules, in section 1917 of the Social Security Act (the Act), and federal regulations at 42 C.F.R. 435.700, et seq., apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules (“MAGI individuals”) and receive coverage for long-term services and supports (LTSS).

The annual Medicaid Long Term Services and Supports expenditure report includes Medicaid expenditures for all LTSS, including institutional and non-institutional settings, by service category and state. The data come primarily from CMS-64 reports.

Published monthly, this report and website tool focuses on state actions in managed care for people who receive Medicaid-funded LTSS and on state initiatives relating to services and costs. The Tracker includes updates on State Demonstrations to Integrate Care for Dual Eligible Individuals, the Balancing Incentives Payment Program (BIPP), states developing or implementing Medicaid State Plan amendments under §1915(i), and states pursuing the Communities First Choice Option under §1915(k).

State aging and disability agencies have operated within a tumultuous environment for the past several years. It has become increasingly more difficult to reconcile the needs of older adults and people with disabilities with the resources available to address those needs. Five themes are identified from the 2012 state of aging and disabilities surveys, which include the acceleration of Medicaid managed long term services and supports and continuing loss of historical knowledge around the nation.

There are many opportunities for states’ Medicaid information systems and administrative functions to be federally subsidized with funding. This brief describes the variety of administrative systems that qualify for federal financial participation (FFP), including the Medicaid Management Information System (MMIS) and health information technology (HIT). The systems are used to support people with disabilities and older adults.

Held in May 2005 this national conference was designed to meet the unique training needs of waiver program operators. This year’s conference, titled "The Sun Shines Brighter at Home," offered substantive opportunities to learn about the national initiatives, policy directions and grant programs that shape the current environment. The attached agenda has links to all of the presentation overheads.

This report describes important system-of-care principles that have shaped the services for youth with SEDs, the role of the various agencies and the financing used by many states. It identifies and critiques four financing mechanisms: HCBS waivers, the Medicaid rehabilitation option, case rates for high risk populations, and provisions in the Tax Equity and Fiscal Responsibility Act (TEFRA). The paper ends with a synthesis of research questions and implications for legislative efforts.

This table is modified from previous chart received during CMS Presentation at 2003 HCBS Waiver Conference (October 28, 2003 Milwaukee, WI) and in draft form. It compares the 1915c, 1115, or DRA for the following issues: Level of Care/ Eligibility, Combining Populations, Budget Neutrality, Reporting, Renewal, and Evaluation, Support Brokerage, Cash Allowance, Hiring Legally Responsible Individuals, Provider Agreements, Direct Payment to Providers, Payment for Services.

The purpose of this study was to describe the two ways in which Medicaid offers personal care services to low-income Americans: Medicaid Title XIX Personal Care Services (PCS) optional state plan benefit; and the Medicaid 1915(c) Home and Community-Based Services (HCBS) waivers program. A summary of the findings of this study are presented here as well as the article that appeared in the Health Care Financing Review, Summer 2001.