Today, my meeting with Deputy Governor Cristal Thomas and other advocates will involve
Section 1115 Demonstration Waivers.
The State of Illinois is launching an effort to develop a Path to Transformation Medicaid Waiver
under the Centers for Medicare and Medicaid Services waiver authority, Section 1115 of the Social
Security Act. The State is looking to establish a more integrated, rational, and efficient healthcare
delivery system. They are seeking input from stakeholders to help shape the goals and key strategies
of the waiver. At this meeting, the State will introduce the guiding principles of the waiver, explain the
federal Section 1115 waiver requirements and submission/approval process, and discuss the process
by which the State will engage stakeholders and the public in development and review of a waiver
proposal.
I find this meeting to be very interesting, because many states are looking at 1115 Waivers right now.
In my opinion, if people with intellectual and other developmental disabilities (I/DD) were included, it would create an entitlement to ‘medically appropriate’ services, including long term supports and services (LTSS).
Arizona, the state that has been running I/DD services (acute and LTSS) under a managed care model
with an 1115 for many years, has no waiting list. And in Arizona, the state Division acts as the
Managed Care Organization which contracts with providers for both medical/acute care and long-term
supports and services.
Here is what the Centers for Medicare & Medicaid say about 1115 Waivers.
About Section 1115 Demonstrations
Section 1115 of the Social Security Act gives the Secretary of Health and Human Services
authority to approve experimental, pilot, or demonstration projects that promote the objectives of
the Medicaid and CHIP programs. The purpose of these demonstrations, which give States additional
flexibility to design and improve their programs, is to demonstrate and evaluate policy approaches
such as:
· Expanding eligibility to individuals who are not otherwise Medicaid or CHIP eligible
· Providing services not typically covered by Medicaid
· Using innovative service delivery systems that improve care, increase efficiency, and
reduce costs.
In general, section 1115 demonstrations are approved for a five-year period and can be renewed,
typically for an additional three years. Demonstrations must be “budget neutral” to the Federal
government, which means that during the course of the project Federal Medicaid expenditures will
not be more than Federal spending without the waiver.
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)
Tony@www.thearcofil.org
