{"id":296,"date":"2017-08-03T00:00:00","date_gmt":"2017-08-03T00:00:00","guid":{"rendered":"https:\/\/eccovia.com\/index.php\/2017\/08\/03\/whats-name-skinny-1915c-hcbs-medicaid-waivers-drive-community-care\/"},"modified":"2024-03-14T17:10:58","modified_gmt":"2024-03-14T17:10:58","slug":"whats-name-skinny-1915c-hcbs-medicaid-waivers-drive-community-care","status":"publish","type":"post","link":"https:\/\/eccovia.com\/blog\/whats-name-skinny-1915c-hcbs-medicaid-waivers-drive-community-care\/","title":{"rendered":"How 1915(c) HCBS Medicaid Waivers Drive Community Care"},"content":{"rendered":"
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Innovative care models are being tested around the country for vulnerable population groups such as those with mental illness, intellectual or developmental disabilities. One of the key issues at the heart of the healthcare debate is how to uniquely apply federal mandates in states and communities with these high-risk populations. Recognizing the flexibility that may be needed as communities try to accommodate federal guidelines to their unique situations, CMS strives to enable states, counties, and local providers to adhere to their guidelines without sacrificing quality of care for individuals in their community. Medicaid Waivers are one way CMS allows for this unique customization.<\/p>\n

Waivers provide CMS with the federal statutory authority they need to exempt states from certain Medicaid requirements. It is important to note that these waivers are different from individual state plan amendments (which may require states to renew every 3-5 years) and may include enrollment limits or waiting lists as they are not considered entitlements.<\/p>\n

Included in the list of Medicaid waivers is the 1915(c). First introduced by President Reagan\u2019s Omnibus Reconciliation Act of 1981, the 1915(c) waiver allowed states to create a unique package of services targeting individuals requiring an institutional level of care. Under the 1915(c) waiver, patients would now be able to receive Home and Community-Based Services (HCBS) such as rehabilitation, transportation for services, and personal care in their homes or communities rather than institutional settings. These waivers, however, had limitations. For example, they could only serve one of three target groups. Recognizing this, CMS began soliciting input from providers and patients in 2009 regarding how they could improve waiver 1915(c).<\/p>\n

As a result of feedback received, regulations were updated in 2014 and these waivers now allow providers to combine multiple conditions and populations under a single waiver, and can also be combined with a 1915(b) Freedom of Choice waiver to implement managed care. This change removes a barrier for states wishing to develop a waiver that meets the needs of multiple target populations. The rule specifies that if a state chooses the option of more than one target group under a single waiver, they must assure CMS that it is able to meet the unique service needs of individuals in each group, and that everyone covered by the waiver has equal access to all needed services.<\/p>\n

State HCBS waiver programs must also meet the following additional guidelines:<\/p>\n