What is a Medicaid Waiver?

Amanda Cavanagh
Director, Research & Business Development


What is a Medicaid waiver?
Home and Community Based Services are available through waiver programs.  Centers for Medicare and Medicaid (CMS) allows states to “waive” certain Medicaid requirements and pay for home and community based services as an alternative to institutions, nursing homes or hospitalization.  These Medicaid waivers help provide services and to allow people to receive long-term care in the community and in their homes.  Waivers are also ways states can test new or existing ways to deliver and pay for health care services in Medicaid and the Children's Health Insurance Program (CHIP).


Types of Medicaid waivers
There are four primary types of waivers and demonstration projects:

1. Section 1115 Research & Demonstration Projects: States can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP.
2. Section 1915(b) Managed Care Waivers: States can apply for waivers to provide services through managed care delivery systems or otherwise limit people's choice of providers.
3. Section 1915(c) Home and Community-Based Services Waivers: States can apply for waivers to provide long-term care services in home and community settings rather than institutional settings.
4. Concurrent Section 1915(b) and 1915(c) Waivers: States can apply to simultaneously implement two types of waivers to provide a continuum of services to the elderly and people with disabilities, as long as all Federal requirements for both programs are met.

Medicaid HCBS can be provided as part of state-plan services or through waivers. State plan HCBS include mandatory services (all states must offer them), and optional services (offered at state discretion). Whether the services are mandatory or optional, if they are provided under the state plan, they must be offered to all eligible individuals. Services provided under waivers may be restricted to specific groups based on geographic region, income, or type of disability. Waivers may include a wider range of service types than can be provided under state plans. Individuals may receive both state plan and waiver services.


How iLIFE supports Medicaid waiver programs
iLIFE offers a full range of financial services to support federal and state Medicaid Waiver programs.  iLIFE helps people in Medicaid Waiver programs by: 

• guiding employers through the hiring process.
• ensuring workers are qualified caregivers.
• receiving time reports.
• issuing payments.
• handling tax responsibilities.
• detecting and preventing fraud and abuse.

References:
http://medicaidwaiver.org
http://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/waivers.html
http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/hcbsfindings/hcbsfind3.html

The Changing Landscape of Long-Term Care

Richard Zalewski

iLIFE Program Consultant

My, oh my.  How things have changed.

Thinking back to when our organization took its first steps into the financial management field, the landscape looked very different.  It was 1988.  While more options for services and resources were becoming available to people with disabilities, the practice of people self-directing their services was not widely implemented.

From the 1960s through the ‘80s, self-directed service models sprung out of the independent living movement.  These programs only served small pockets of our country, but they fostered larger principles that would eventually influence future policies and programs.

Now, federal regulations and requirements are driving the transformation of long-term care.  Of course, the Americans with Disabilities Act and the Olmstead decision have been huge.  However, additional financial incentives for states to decrease institutional spending are expanding community based service options.  In 2012, nearly half of the $136 billion Medicaid spent on long-term care went to home and community based services.

Wisconsin’s participant-directed supports program, IRIS, is an increasingly popular option for people wanting to exercise self-direction.  iLIFE is the fiscal employer agent for IRIS, which currently serves over 11,000 participants.  Additionally, veteran-directed service programs (VD-HCBS) have expanded across the United States.  iLIFE provides financial management services to VD-HCBS participants in Wisconsin, Illinois, and the Upper Peninsula of Michigan.

As more long-term care programs become available and self-directed options expand, financial management service providers are in a unique position to help people and their families better live and work in their community.

Over the past quarter century, there has been a great deal of change.  I hope this commitment stays the same.

Learn more about our services at iLIFEfms.com.