With the opioid epidemic continuing, state interest in expanding access to substance use disorder (SUD) services remains high. Medicaid financed 21% of SUD services and 25% of mental health services in 2014. Section 1115 waivers related to behavioral health remain the most frequent type of waiver sought and obtained by states, with most requesting authority to use federal Medicaid funds for services provided in “institutions for mental disease” (IMDs). Since Medicaid’s inception, Congress has prohibited states from using Medicaid funds for IMD services for non-elderly adults. This brief provides new data and answers key questions about the Medicaid IMD payment exclusion as waiver activity continues, and Congress considers legislative changes, including a House bill that would restrict IMD SUD services to those with opioid use disorder, excluding those with other SUDs.
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Only Six Percent of Adult Medicaid Enrollees Targeted by States’ New Work Requirements Are Not Already Working and Are Unlikely to Qualify for an Exemption
Among enrollees targeted in the push for work requirements for “able-bodied adults” in Medicaid, only 6 percent are not already working and unlikely to qualify for an exemption, according to an analysis from the Kaiser Family Foundation. Nationally, more than 6 in 10 nonelderly adults in Medicaid who do not…
As of June 2018, four states have approved waivers to implement Medicaid work requirements, seven states have waiver requests pending with CMS, and other states are considering or developing work requirement programs. This brief builds on previous analyses and provides additional detail to examine work and Medicaid, including the work status and types of jobs held by Medicaid adults, the relationship between work and financial stability among Medicaid adults, and potential challenges in fulfilling work, reporting, or exemption process requirements. Data suggest that the population not working and not eligible for an exemption from the work requirements could be narrow, but new requirements would have implications for a broader scope of Medicaid enrollees due to the nature of their jobs and potential barriers to complying with reporting requirements.
This resource tracks states with approved Section 1115 Medicaid waivers and pending waivers (which include new waiver applications, waiver amendments, and renewals). View approved and pending waivers according to waiver category. Related waiver resources are available by topic at the bottom of the page, as are additional details on each approved and pending waiver.
This interactive map shows the status of all Section 1332 waivers requested by states. The Affordable Care Act (ACA) allows states to apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets and can be used to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents.
This issue brief provides Medicaid highlights from governors’ proposed budgets for state fiscal year (FY) 2019 (July 1, 2018 through June 30, 2019 in most states). Proposed budgets reflect the priorities of the governor and are often blueprints for the legislature to consider. In total, we reviewed 39 proposed state budgets and text from 46 state of the state speeches. This review revealed that while state revenue collections improved in 2017 compared to 2016, considerable economic and regional variation persists, many states are facing significant budget challenges unrelated to Medicaid such as unfunded pension liabilities or falling oil prices, and the outlook for 2018 remains uncertain due, in part, to the impacts of the 2017 Federal Tax Reform Act.
How Might Older Nonelderly Medicaid Adults with Disabilities Be Affected By Work Requirements in Section 1115 Waivers?
Most of the states with approved or pending Section 1115 waivers that condition Medicaid eligibility on work would apply those requirements to all or most nonelderly adults (ages 19-64) who are not receiving Supplemental Security Income (SSI) cash assistance, including older nonelderly adults (ages 50-64). Older nonelderly adults may be limited in their ability to satisfy a work requirement due to barriers resulting from age and/or disability. Previous analysis shows that many nonelderly Medicaid adults (ages 19-64) have functional limitations that may interfere with their ability to work but do not rise to the stringent SSI level of disability, making them potentially subject to work requirements. Older nonelderly adults are over twice as likely to have a disability than younger adults (17% vs. 7%). Furthermore, older nonelderly adults account for nearly half (45%) of all nonelderly Medicaid adults with a disability but not SSI who could be affected by a work requirement. This analysis examines the implications of work requirements for Medicaid adults ages 50 to 64 (referred to as “older nonelderly Medicaid adults”) and provides national and state level estimates of their disability, SSI, and work status using data from the 2016 American Community Survey (ACS).
Data Note: Data Do Not Support Relationship Between Medicaid Expansion Status and Home and Community-Based Services Waiver Waiting Lists
Some have said that state choices about whether to adopt the ACA’s Medicaid expansion come at the expense of providing Medicaid home and community-based services (HCBS). Since 2002, the Kaiser Family Foundation has surveyed states about their HCBS waiver waiting lists. All states offer at least one HCBS waiver for seniors and people with disabilities today. States choose how many people to serve under these waivers, and their ability to limit enrollment can result in waiting lists when the number of people seeking services exceeds the number of waiver slots. This analysis examines the most recent data available, including HCBS waiver waiting list data for 2015 and 2016. The data do not support a relationship between a state’s Medicaid expansion status, which is primarily financed with federal funds, and changes in its HCBS waiver waiting list.
In an Axios column, Drew Altman discusses how, ironically, efforts by red states to move their ACA marketplaces and their Medicaid programs in more conservative directions could end up strengthening the ACA and Medicaid politically over the longer term.
Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states considerable flexibility in how they operate their programs, beyond what is available under current law. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS). This brief answers basic questions about Section 1115 waiver authority and discusses the current landscape of approved and pending demonstration waivers.