Technical Assistance Partnership for Child and Family Mental Health

August 2003

Question:

What is a 1915(b) Waiver?

Answer:

A 1915(b) waiver is one of a series of waivers for which Medicaid State agencies can apply. As outlined in a previous frequently asked question, State Medicaid agencies are responsible for the day-to-day management of the program, and States must comply with Federal legislative, regulatory, and guideline requirements. These requirements can be waived to expand services or provide more cost-effective services.

States are permitted to waive statewideness , comparability of services , and/or freedom of choice . Statewideness requires States to provide the same set of services throughout the State; they cannot vary benefits depending on geographic location. Comparability of services requires States to provide the same set of services to various groups of people who are Medicaid eligible. For example, States must provide the same set of services to individuals who are on Temporary Assistance for Needy Families (TANF) and those on Supplemental Security Income (SSI). Freedom of choice allows Medicaid-eligible people the freedom to pick their providers from among all who participate in the Medicaid program, within their areas of specialty. The 1915(b) waivers are limited in that they apply to existing Medicaid-eligible beneficiaries; authority under this waiver cannot be used for eligibility expansions. There are four 1915(b) Freedom of Choice Waivers:

Mandates Medicaid enrollment into managed care
Utilizes a "central broker," an independent individual or group that helps Medicaid-eligible individuals choose the appropriate provider(s) that most fits their needs
Uses cost savings to provide additional services
Limits the number of providers for services

States often use a combination of these four programs. For example, a program could mandate enrollment into a managed care program while offering a set of services that are much more expansive. In other words, a State can

Create a "carveout" delivery system for specialty care, for example, a Managed Behavioral Health Care Plan;
Create programs that are not available Statewide; and
Provide an enhanced service package, which allows the State to provide additional services to Medicaid beneficiaries by using savings from a managed care product.

The State Medicaid agency must be the entity that applies for the waiver. In the case of 1915(b) waivers, the State can apply to the Regional Office rather than the Central Office of the Commission on Medicare and Medicaid Services (CMS). A 1915(b) waiver program cannot have a negative impact on beneficiary access or quality of care services and must be cost effective/cost neutral (cannot cost more than what the Medicaid program would have cost without the waiver).

Once CMS receives the application for a 1915(b) waiver (submitted by the State agency), the program will be deemed approved unless it is acted upon within 90 days. Within this time frame, CMS can approve, disapprove, or stop the 90-day clock on the process if additional information about the program is needed. The waiver programs are approved for 2-year periods and can be renewed on an ongoing basis if the State applies. Information on how to apply for a 1915(b) waiver can be found on the CMS website: http://www.cms.gov/medicaid/1915b/1915apply.asp.

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	August 2003 Question: What is a 1915(b) Waiver? Answer: A 1915(b) waiver is one of a series of waivers for which Medicaid State agencies can apply. As outlined in a previous frequently asked question, State Medicaid agencies are responsible for the day-to-day management of the program, and States must comply with Federal legislative, regulatory, and guideline requirements. These requirements can be waived to expand services or provide more cost-effective services. States are permitted to waive statewideness , comparability of services , and/or freedom of choice . Statewideness requires States to provide the same set of services throughout the State; they cannot vary benefits depending on geographic location. Comparability of services requires States to provide the same set of services to various groups of people who are Medicaid eligible. For example, States must provide the same set of services to individuals who are on Temporary Assistance for Needy Families (TANF) and those on Supplemental Security Income (SSI). Freedom of choice allows Medicaid-eligible people the freedom to pick their providers from among all who participate in the Medicaid program, within their areas of specialty. The 1915(b) waivers are limited in that they apply to existing Medicaid-eligible beneficiaries; authority under this waiver cannot be used for eligibility expansions. There are four 1915(b) Freedom of Choice Waivers: Mandates Medicaid enrollment into managed care Utilizes a "central broker," an independent individual or group that helps Medicaid-eligible individuals choose the appropriate provider(s) that most fits their needs Uses cost savings to provide additional services Limits the number of providers for services States often use a combination of these four programs. For example, a program could mandate enrollment into a managed care program while offering a set of services that are much more expansive. In other words, a State can Create a "carveout" delivery system for specialty care, for example, a Managed Behavioral Health Care Plan; Create programs that are not available Statewide; and Provide an enhanced service package, which allows the State to provide additional services to Medicaid beneficiaries by using savings from a managed care product. The State Medicaid agency must be the entity that applies for the waiver. In the case of 1915(b) waivers, the State can apply to the Regional Office rather than the Central Office of the Commission on Medicare and Medicaid Services (CMS). A 1915(b) waiver program cannot have a negative impact on beneficiary access or quality of care services and must be cost effective/cost neutral (cannot cost more than what the Medicaid program would have cost without the waiver). Once CMS receives the application for a 1915(b) waiver (submitted by the State agency), the program will be deemed approved unless it is acted upon within 90 days. Within this time frame, CMS can approve, disapprove, or stop the 90-day clock on the process if additional information about the program is needed. The waiver programs are approved for 2-year periods and can be renewed on an ongoing basis if the State applies. Information on how to apply for a 1915(b) waiver can be found on the CMS website: http://www.cms.gov/medicaid/1915b/1915apply.asp.

Primary Care and Systems of Care Frequently Asked Questions

Primary Care and Systems of Care
Frequently Asked Questions