Medicaid Retroactive Coverage Waivers: Implications for Beneficiaries, Providers, and States

Issue Brief
  1. CMS, Special Terms and Conditions, Iowa Wellness Plan, #11-W-00289/5 (Jan. 1, 2017-Dec. 31, 2019, amended Oct. 26, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ia/ia-wellness-plan-ca.pdf.

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  2. 42 U.S.C. § 1396a (a) (34) (“A State plan for medical assistance must provide that in the case of any individual who has been determined to be eligible for medical assistance under the plan, such assistance will be made available to him for care and services included under the plan and furnished in or after the third month before the month in which he made application (or application was made on his behalf in the case of a deceased individual) for such assistance if such individual was (or upon application would have been) eligible for such assistance at the time such care and services were furnished.”)

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  3. The original waiver was approved in December, 2013 to implement Iowa’s ACA expansion.  The waiver provisions for ACA expansion adults have been amended several times, and in July 2017, the waiver’s dental program (including tiered benefits, premiums, and healthy behavior incentives) was expanded to include all Medicaid adults.

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  4. CMS Special Terms and Conditions, Iowa Wellness Plan, #11-W-00289/5 (Jan. 1, 2017-Dec. 31, 2019, amended Oct. 26, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ia/ia-wellness-plan-ca.pdf.

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  5. CMS Letter from Brian Neale, Director, Center for Medicaid and CHIP Services to Mikki Stier, Medicaid Director, Iowa Dep’t of Human Services (Oct. 27, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ia/ia-wellness-plan-ca.pdf.

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  6. Id. 

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  7. CMS Special Terms and Conditions, Iowa Wellness Plan, #11-W-00289/5 (Jan. 1, 2017-Dec. 31, 2019, amended Oct. 26, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ia/ia-wellness-plan-ca.pdf.

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  8. State of Iowa, Dep’t of Human Services, Iowa Wellness Plan, Project #11-W-00289/5, Section 1115 Demonstration at 5 (Aug. 2, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ia/ia-wellness-plan-pa4.pdf.

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  9. Id. at 7.

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  10. Id. 

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  11. Id. at 6; see also Iowa House File 653, https://www.legis.iowa.gov/docs/publications/LGE/87/HF653.pdf.

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  12. State of Iowa, Dep’t of Human Services, Iowa Wellness Plan, Project #11-W-00289/5, Section 1115 Demonstration Amendment, Attachment A – Public Notice at 2 (Aug. 2, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ia/ia-wellness-plan-pa4.pdf.

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  13. Id.

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  14. Kaiser Family Foundation, Section 1115 Medicaid Expansion Waivers:  A Look at Key Themes and State Specific Waiver Provisions (Aug. 16, 2017), https://www.kff.org/medicaid/issue-brief/section-1115-medicaid-expansion-waivers-a-look-at-key-themes-and-state-specific-waiver-provisions/.

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  15. Id. 

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  16. Kaiser Family Foundation, An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana (Jan. 2017), https://www.kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/.

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  17. CMS Special Terms and Conditions, Delaware Diamond State Health Plan, #11-W-00036/4 (Sept. 30, 2013-Dec. 31, 2018), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/de/de-dshp-ca.pdf.

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  18. CMS Special Terms and Conditions, MassHealth Medicaid Section 1115 Demonstration, #11-W-00030/1 (July 1, 2017-June 30, 2022), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ma/ma-masshealth-ca.pdf; see also M.G.L. ch. 118E, § 9A (6), https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVII/Chapter118E/Section9A.

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  19. CMS Special Terms and Conditions, Maryland HealthChoice Medicaid Section 1115 Demonstration, #11-W-00099/3 (Jan. 1, 2017-Dec. 31, 2021), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/md/md-healthchoice-ca.pdf.

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  20. CMS Special Terms and Conditions, TennCare II, #11-W-00151/4 (Nov. 16, 2016-June 30, 2021), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/tn/tn-tenncare-ii-ca.pdf.

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  21. CMS Special Terms and Conditions, Utah Primary Care Network #11-W-00145/8 (Nov. 1, 2017-June 30, 2022), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ut/ut-primary-care-network-ca.pdf.

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  22. State of Iowa, Dep’t of Human Services, Iowa Wellness Plan, Project #11-W-00289/5, Section 1115 Demonstration Amendment (Aug. 2, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ia/ia-wellness-plan-pa4.pdf.

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  23. CMS letter from Vikki Wachino, Director, Center for Medicaid and CHIP Services to Tyler Ann McGuffee, Insurance and Healthcare Policy Director, Office of Governor Michael R. Pence (July 29, 2016), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-lockouts-redetermination-07292016.pdf.

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