Key Themes From Delivery System Reform Incentive Payment (DSRIP) Waivers in 4 States

Issue Brief
  1. Under the budget neutrality rules for Medicaid 1115 waivers, states and the CMS agree upon a “without waiver” baseline that represents the amount a state would have spent on Medicaid in the absence of the waiver.  The state is then allowed to receive federal Medicaid matching funds for amounts up to the without waiver baseline level, including for activities that otherwise would not be matchable but for the Medicaid 1115 waiver.  If a state’s actual spending comes in below the without waiver baseline, it may be allowed to “bank” those savings and potentially use them to finance activities for future Medicaid 1115 waivers.











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