The transformation of all Medicaid services in Illinois is moving ahead very quickly and
there are many implications for individuals with disabilities and the entire human service
system through a Path to Transformation Medicaid Waiver. The state has over the past two
years laid much of the groundwork necessary for this transformation as a result of health
care reform and the Alliance for Health grant.
Last Friday, Deputy Governor Cristal Thomas and Michael Gelder from the Governor’s Office
kicked of a meeting about dramatically transforming the Illinois Medicaid System. This trans-
formation would result by submitting a 1115 Waiver to Centers for Medicare & Medicaid (CMS).
Health Management Associates has been hired to work with the Administration to submit an 1115
Waiver to CMS by February 15, 2014, on a very aggressive timeframe to say the least.
The state’s plan, as I understand it, is to collapse all of the ten waivers in Illinois into an 1115
Waiver. While it would not be a “block grant,” a 1115 Waiver is about giving the state more
flexibility to innovate and develop person centered supports/services. Throughout the meeting,
the State of Oregon and its 1115 Waiver as used as an example of Medicaid Reform Illinois could
model. After talking to some friends in Oregon, I have learned that Oregon only uses its 1115
Waiver for managed care of health services. What is being considered by the Administration
would be a first in the nation. It would be much more comprehensive than the Oregon model.
I think my first thoughts on this Medicaid transformation would be similar to my comments
regarding our position on managed care. This transformation must have the necessary safeguards
and investment in community inclusion and not create a “medically driven” transformation of Medicaid.
Some questions would be:
1. What would be the status of the Dept of Human Services?
2. Would the Division of Developmental Disabilities continue to exist?
3. Would the waiting list be eliminated?
4. Would the Dept of Health Care & Family Services become a super human service entity?
Here are my comments from Friday on the 1115 Waiver
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
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
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
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.