Tag Archives: waiver

CMS Announces new Medicare-Medicaid ACO Model

Currently, nearly 10 million Americans are dually-eligible for both Medicare and Medicaid. These “dual eligibles” are low-income seniors and individuals with disabilities who are separately eligible for and receive coverage under both the Medicare and Medicaid programs.  In general, Medicare acts as the primary payer for dual-eligibles, while Medicaid provides “wrap-around” coverage for these individuals, helping with some out-of-pocket costs (such as premiums, copayments and deductibles) and offering coverage for services not otherwise covered by Medicare (vision,… More

CMS and Massachusetts Advance Delivery System Reform with Approval of New 1115 Waiver

On November 4, 2016, the Centers for Medicare & Medicaid Services (“CMS”) sent word to the Massachusetts Executive Office of Health and Human Services (EOHHS, referred to here as “MassHealth”) that it approved a major amendment to Massachusetts’ section 1115 demonstration project through June 30, 2017.  At the same time, CMS also approved an extension of this same demonstration through June 30, 2022. Approval of Massachusetts’ waiver amendment comes after nearly a year of negotiations and may ultimately result in the transition of the vast majority of MassHealth enrollees into newly-formed Accountable Care Organizations (“ACOs”) operating under one three models,… More

Everything you have ever wanted to know about Medicaid waivers

We frequently read about state Medicaid programs receiving or being granted “waivers” by CMS, but what does that mean exactly?  What is a “waiver”?  What is the history of Medicaid waivers?  How does the process work?  We hope to answer these questions in this blog post.

The Legal Standard

A “waiver” refers to authority that the Secretary of Health and Human Services possesses under section 1115 of the Social Security Act:

“(a)  In the case of any experimental,… More