Technical Assistance Partnership for Child and Family Mental Health

September 2003

What is a 1915 (c) Waiver?

Answer:

A 1915 (c) Home and Community-based Services (HBCS) 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 are required to comply with federal legislative, regulatory, and guideline requirements. These requirements can be "waived" to expand services and to provide more cost-effective services.

Under 1915 (c) waivers states are permitted to waive statewideness , comparability of services , and/or freedom of choice as they are in 1915 (b) waivers. (See Frequently Asked Question from August 2003 for explanation of 1915 (b) waiver and for definition of "statewideness," "comparability of services," and "freedom of choice.") In addition to these three categories, states can waive community income and resource rules . Community income and resource rules found under section 1902 (a) (10) (C) (i) (III) of the Social Security Act require that states apply a single standard in determining Medicaid eligibility. The waiver of this standard allows the Medicaid state agency to cover individuals who might not be eligible for Medicaid because of their income and resources. To become eligible, these individuals would be forced into institutions for their care. However, under a 1915 (c) waiver, these individuals could receive services in the community. As is the case with 1915(b) waivers, 1915(c) waivers are limited in that they apply to existing Medicaid eligible beneficiaries; authority under this waiver cannot be used for eligibility expansions.

States have the flexibility to design HCBS waiver programs to meet the specific needs of defined groups. Federal regulations permit HCBS waiver programs to serve the elderly and persons with physical disabilities, developmental disabilities, mental retardation, or mental illness. States may also target HCBS waiver programs by specific illness or condition, such as technology-dependent children or individuals with AIDS, as well as persons with acquired or traumatic brain injury. States can make home and community- based services available to individuals who would otherwise qualify for Medicaid only if they were in an institutional setting. In other words, individuals receiving services under an HCBS waiver program must be persons who need mental retardation level of care and who would typically receive services in a hospital, nursing facility, or intermediate-care facility.

States may offer a variety of services to participants under an HCBS waiver program and are not limited to the number of services that can be provided. States may use an HCBS waiver program to provide a combination of both traditional medical services (e.g., dental services, skilled nursing services) as well as nontraditional services (e.g., respite, case management, partial hospitalization, day treatment). No specific services must be offered in an HCBS waiver program. Additionally, there is no limit to the number of services that can be offered under a single waiver program as long as the waiver retains cost neutrality and the services are necessary to avoid institutionalization.

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	September 2003 What is a 1915 (c) Waiver? Answer: A 1915 (c) Home and Community-based Services (HBCS) 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 are required to comply with federal legislative, regulatory, and guideline requirements. These requirements can be "waived" to expand services and to provide more cost-effective services. Under 1915 (c) waivers states are permitted to waive statewideness , comparability of services , and/or freedom of choice as they are in 1915 (b) waivers. (See Frequently Asked Question from August 2003 for explanation of 1915 (b) waiver and for definition of "statewideness," "comparability of services," and "freedom of choice.") In addition to these three categories, states can waive community income and resource rules . Community income and resource rules found under section 1902 (a) (10) (C) (i) (III) of the Social Security Act require that states apply a single standard in determining Medicaid eligibility. The waiver of this standard allows the Medicaid state agency to cover individuals who might not be eligible for Medicaid because of their income and resources. To become eligible, these individuals would be forced into institutions for their care. However, under a 1915 (c) waiver, these individuals could receive services in the community. As is the case with 1915(b) waivers, 1915(c) waivers are limited in that they apply to existing Medicaid eligible beneficiaries; authority under this waiver cannot be used for eligibility expansions. States have the flexibility to design HCBS waiver programs to meet the specific needs of defined groups. Federal regulations permit HCBS waiver programs to serve the elderly and persons with physical disabilities, developmental disabilities, mental retardation, or mental illness. States may also target HCBS waiver programs by specific illness or condition, such as technology-dependent children or individuals with AIDS, as well as persons with acquired or traumatic brain injury. States can make home and community- based services available to individuals who would otherwise qualify for Medicaid only if they were in an institutional setting. In other words, individuals receiving services under an HCBS waiver program must be persons who need mental retardation level of care and who would typically receive services in a hospital, nursing facility, or intermediate-care facility. States may offer a variety of services to participants under an HCBS waiver program and are not limited to the number of services that can be provided. States may use an HCBS waiver program to provide a combination of both traditional medical services (e.g., dental services, skilled nursing services) as well as nontraditional services (e.g., respite, case management, partial hospitalization, day treatment). No specific services must be offered in an HCBS waiver program. Additionally, there is no limit to the number of services that can be offered under a single waiver program as long as the waiver retains cost neutrality and the services are necessary to avoid institutionalization.

Primary Care and Systems of Care Frequently Asked Questions

Primary Care and Systems of Care
Frequently Asked Questions