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Medicaid Waivers for All 50 States

Approved and Pending Section 1115 Waivers (Updated 6/26/2019)

State Waiver Name Type and Date Filed Work Requirement Eligibility and Enrollment Restrictions Benefit Restrictions, Copays, Healthy Behaviors Other
AL Alabama Medicaid Workforce Initiative New – 7/31/18 Updated – 9/10/18 Would require 35 hours a week of work activities, or 20 hours a week for parents of children under 6. Enrollees would have 90 days to comply or lose coverage. As AL has not expanded Medicaid, it would be the first state to impose limits on traditional Medicaid populations. Requirements would not apply to disabled, pregnant, over 60, caregivers for disabled, enrollees of alcohol or substance abuse programs and select others.
AK Alaska Substance Use Disorder and Behavioral Health Program (aka Alaska Medicaid Section 1115 Behavioral Health Demonstration) New – 1/31/18 Approved – 11/20/18 Focuses on support for those with mental illness, severe emotional  disturbance and/or substance abuse
AZ Arizona Health Care Cost Containment System IMD Amendment – 5/3/17 Additional Amendment 1/3/18 Additional Amendment 4/6/18 Approved – 1/18/19 Requires 80 hours a month of work, school, Employment Support & Development activities or any combination of the above, as well as employment search activities for able-bodied age 19-49. Includes an exemption for members of federally recognized Native American tribes. There will be a three month grace period for enrollees to meet the requirements once they are determined to be eligible for the program. Failure to meet the requirements or report compliance during any time after the three month grace period will result in suspension of the enrollee’s benefits for two months. Their eligibility will be reactivated immediately after the suspension if they continue to meet all other eligibility criteria. The community engagement requirement may not begin sooner than January 1, 2020. 5 year max lifetime coverage limit for beneficiaries subject to work requirements was not approved Amendment 4/6 that removes retroactive eligibility, limiting eligibility to the month the application is filed was approved
AR Arkansas Works Approved 3/4/18* * was set aside by the court March 2019.  Will not be implemented unless additional approval The requirement will require non-disabled, childless adults aged 19 to 49 to participate in community engagement activities, including work, training, or volunteering, 80 hours a month. Those that do not comply with the requirements for 3 months out of a year will be locked out of coverage until the following year. Retroactive Eligibility:  The waiver requests permission to: 1) eliminate patients becoming eligible the day of application and 2) eliminate the ability of providers to bill in the three months prior to the application.  The patient’s eligibility would be effective the first day of the month that the patient applies for coverage. This was partially approved. Retroactive eligibility will be limited to 30 days prior to the date of application. CMS approved removing the waiver and expenditure authorities related to the state’s mandatory employee sponsored insurance (ESI) premium assistance program, which the state will eliminate. FPL Changes and changing state designation from a determination state to an assessment state were not approved.
AR Arkansas’ Tax Equity and Fiscal Responsibility Act Extension Last approved 5/9/18- Valid through Dec. 31, 2022 Provides services to disabled children who meet the criteria for the optional Medicaid category commonly referred to as the “Katie Beckett Option” that was enacted into Medicaid law under section 134 of the Tax Equity and Fiscal Responsibility Act (TEFRA) (P.L. 97-248).  The “TEFRA population” (also known as “Katie Beckett children”) are children age 18 or younger with long-term disabilities, mental illness, or complex medical needs, in families with income that is too high to qualify for Medicaid, who could become Medicaid eligible if receiving extended care in an institutional setting.  The TEFRA Medicaid eligibility option allows these disabled children to become Medicaid eligible based on their own income and resources in order to receive medical services in (less-costly) home-settings instead of in an institution.
CA California Medi-Cal Extension/amendment – approved 6/7/18
CO Colorado Adult Prenatal Coverage and Premium Assistance CHP+ Extension Approved 9/16/15 – Valid through 7/31/20 Provides coverage for uninsured pregnant women with income above 141% through 195% FPL.
DE Delaware Diamond State Health Plan Extension for current program – 7/13/2018 Amendment – 7/13/2018 Pending  – Requests amendment to provide coverage for substance use disorder services provided in institution for mental diseases.
DC DC Behavioral Health Transformation New – filed 6/3/19 Requests Medicaid reimbursement for Institutions for Mental diseases for inpatient, residential and other treatment for adults with substance use disorders.
FL Florida Medicaid Family Planning Waiver Extension Approved through 6/30/2023 Request 5 year extension through December 2022 with no substantive changes
FL Florida Managed Medical Assistance Amendments: 11/14/2016 4/26/2018 5/3/2018 Seeks to eliminate the 3 month retroactive eligibility period for non-pregnant adults over age 21. Behavioral Health Amendment to provide coverage for health services and housing assistance for persons aged 21 and older with serious mental illness or substance abuse disorders who are at or in risk of homelessness. PSHP- seeking amendment to operate a statewide prepaid dental health program.
GA Georgia Planning for Healthy Babies New Tempextension granted 3/29/19 – approved through 6/30/19 Extension Approved 2/28/18 New Extension filed 12/21/18 Received a temporary 1 year extension March 1, 2018 Requesting a 10 year extension to make waiver valid through March 31, 2029. New temporary extension through June 30, 2019.
HI Hawaii QUEST Integration Amendment – August 19, 2017 CMA approved additional Amended 10/31/18 6 month temporary extension approved 12/6/18, approved through 6/30/2019 Requests amendment to provide supportive housing services under Medicaid for beneficiaries who are chronically homeless and have behavioral or physical illness and substance abuse disorders.
IL Illinois Behavioral Health Transformation New – October 20, 2016 Approved 5/7/2018 Technical corrections issued 8/16/18 Regards program for behavioral health and substance abuse
IN Healthy Indiana Plan (HIP) 2.0 Extension Approved 1/31/18 With this approval, the state is authorized to make several changes to HIP, which the state has indicated are designed to improve member outcomes by targeting tobacco cessation, substance use disorder (SUD), chronic disease management, and community engagement. HIP also aims to help prepare beneficiaries for participation in the commercial insurance marketplace.
IN Indiana End State Renal Disease Extension Approved 7/28/16 Enables Indiana to implement the End Stage Renal Disease (ESRD) Medicaid section 1115 demonstration. It increases overall coverage of low-income individuals with a diagnosis of ESRD in the state and ensuring access to comprehensive coverage for low-income individuals who have a diagnosis of ESRD and primary coverage through Medicare.
IA Iowa Wellness Plan Amendment approved 10/27/17 3 month retroactive eligibility waived as of Oct. 27. 2017
KS KanCare Extension – December 19, 2017 Approved 12/18/18 Not approved- Would require able bodied adults to work hours in alignment to TANF program requirements (20-30 hours for 1 adult household, 35-55 for 2 adults) Not approved- Members who are subject to work requirements but do not meet them will only get 3 months coverage in 36 month period before losing eligibility – letter sent from CMS 5/7/18 that states no lifetime limits will be imposed Approved Plan works to: -Continue Managed care to increase program sustainability – Increasing program sustainability and advancing payment models – Improving the SUD program -establishing the Disability and Behavioral Health Employment Support Pilot program Waiver did not approve work requirements or eligibility changes
KY Kentucky Health Approved 11/19/18 Following the March 27, 2019 ruling buy the U.S. District Court for the District of Columbia, the only provisions that remain is effect are the waiver for methadone treatment services for all Medicaid Beneficiaries except pregnant women and former foster youth, SUD program, extension of coverage for former foster care youth, and alignment of beneficiary’s annual redetermination with their employer sponsored insurance open enrolment period. the 80 hour a month work requirement, removal or retroactive eligibility, premiums, and disenrollment policies are suspended pending an appeal of the case.
LA Healthy Louisiana Substance Use Disorder New Approved 1/31/18 This SUD demonstration authorizes Louisiana to receive federal financial participation (FFP) for the continuum of services to treat addiction to opioids or other substances, including services provided to Medicaid enrollees with substance use disorder residing in certain residential treatment facilities that meet the definition of an Institution for Mental Disease (IMD).
ME MaineCare New – 08/02/2017 Approved 12/20/18 Maine Withdrew 1/22/19 Would require work or community engagement for able bodied adults, age 19-64, similar to TANF and SNAP, generally 20 hours a week or 24 volunteer hours a month, or part time enrollment in school Members who are subject to work requirements but do not meet them will only get 3 months coverage in 36 month period before losing eligibility. May get an additional month of eligibility in exceptional circumstances. Retroactive eligibility-Coverage would begin on the first day of the month in which an application is received. Long term care coverage would still be eligible for retro eligibility. Seeks to eliminate the option for hospitals to make presumptive eligibility determinations. Seeks to apply a $5000 asset test for MAGI households and eliminate prohibitions on transfer penalties on some annuities. Monthly premiums for able-bodied adults ages 19-64. Failure to pay will result in disenrollment for a period of 90 days or until unpaid premiums are paid. $10 copayments for nonemergency use of the ED Creates work requirements, copayments, and monthly premiums. Eliminates retroactive eligibility and presumptive eligibility.
ME Maine Section 1115 Demonstration for Individuals with HIV/AIDS Extension – filed 5/10/18. Approved through 12/31/2028 No substantial modifications
MD Maryland Healthy Choice Amendment – 07/02/2018 Approved through 12/31/2021 Asks to cover National Diabetes Prevention Program services, pay for substance abuse disorder and mental health issues at Institutes of Mental Disease, cover limited dental benefits for adults, expand the cap of the Assisted Community Integration Services, and remove the Family Planning Program from the waiver.
MA MassHealth Amendment 09/20/2017 Approved 12/14/17 Amendment approval 6/27/18 Demonstration approval 10/23/18 Amendment approval 6/21/19 Intend to shift non-disabled adults ages 21-64 with incomes over 100% FPL into subsidized health plans through the Health Connector. Intend to consolidate coverage for non-disabled adults ages 21-64 with incomes less than 100% FPL in coverage that aligns more closely with commercial coverage. Eliminate redundant MassHealth Limited coverage for adults who are also eligible for coverage through the Health Connector. Aim to implement a cost sharing limit of 5% on income on an annual basis, rather than a quarterly basis. Request to implement cost sharing greater than 5% of income for members over 300% FPL. Limit premium assistance cost sharing to MassHealth enrolled providers. Aim to align coverage for non-disabled adults with commercial plans. Work to adopt widely used commercial tools to obtain lower drug prices and enhances rebates. Reduce costs while improving care by encouraging enrollment in ACOs and MCOs. Remove requirements for multiple MCO options in certain areas of the state. Remove restrictions on payments to IMDs. Additional support for access to health for veterans and their families. 6/21/19 – Authorized MA to treat state veteran annuity as non-countable income for post-eligiility treatment of income rules and calculations.
MI Michigan Pathway to Integration New – July 7, 2016 Approved 4/5/19 – valid through 9/30/2024 Proposal for people with severe mental illness, substance use disorders, intellectual and developmental disabilities and children with serious emotional disturbances. Aims to combine under a single waiver authority all services for eligible populations and increase state flexibility in care.
MI Michigan Brain Injury Waiver New – January 11, 2017 Withdrawn – 10/4/2018 Would provide specialized rehabilitative care and support to a limited population of adults who have suffered qualifying brain injuries.
MI Flint Michigan Section 1115 Demonstration New – 2/15/16 Approved – 3/2/16, 8/8/2017 Approved expenditures for evaluation of potential lead exposure in the homes of eligible children under age 21 and pregnant women in Flint from April 2014 to future specified date.
MI Healthy Michigan Extension – December 6, 2017 Approved 12/20/18 In order to maintain their coverage, able-bodied adults aged 19-62 will need 80 hours of community engagement activity a month. Individuals who fail to meet the requirements for 3 months in a 12 month period will be unenrolled from the program at the end of the fourth month for at least one month. If during the fourth month the individual is able to comply with the 80 hour requirement, they will remain enrolled. Disenrolled individuals who wish to re-enter the program will need to demonstrate that they have completed 80 hours of community engagement activities in the calendar month prior to reenrollment. Additional requirements were approved for enrollees with income between 100-133% FPL who have been enrolled in the program for 48 or more cumulative months, beginning April 1, 2014. These enrollees will be required to complete a health risk assessment or have completed a healthy behavior within the previous year, which include activities like annual preventative visits, receiving appropriate vaccinations, and preventative screenings and testing. Additionally, these enrollees will be required to pay a premium of 5% of their income, in lieu of copayments and coinsurance. The requirements may go into effect no sooner than January 1, 2020.
MN Minnesota Reform 2020 Extension – August 7, 2017 Changes withdrawn – Extension continued Temporary extension granted through 6/30/19 Extension to provide support for the Alternate Care program, which provides support for seniors who are not yet eligible for Medicaid to divert nursing home admissions, making sure people eligible for personal care supports don’t lose benefits and continuing to cover children under age 21 who do not meet the definition of institutional level of care.
MN Minnesota Prepaid Medical Assistance Plus Project Extension Approved 2/10/16 Allows for -Medicaid coverage for one-year olds with incomes above 275 percent of the federal poverty level (FPL) and at or below 283 percent of the FPL; -Waiver of requirements to redetermine the basis for eligibility for Medicaid Caretaker adults with incomes at or below 133 percent of the FPL living with child (ren) age 18 who are not full time secondary school students; -Full Medical assistance benefits for pregnant women during their hospital presumptive eligibility period; and, -Graduate Medical Education (GME) payments through the Medical Education and Research Costs (MERC) trust fund.
MN Minnesota Spousal Impoverishment New – 2014, but never completed Shows pending, but incomplete as of 2014
MN Minnesota Urban Indian Health Board 1115 Demonstration New – filed 5/22/2017, completed 5/18/17, but never implemented or finalized Shows pending, but incomplete as of 1/26/2017 Completeness letter – 5/18/2017
MN Minnesota Substance Use Disorder System Reform New – 3/28/2018, completed 5/21/18, but never implemented or finalized Completeness letter 5/21/18
MS Healthier Mississippi MS Extension – October 16, 2017 Approved 9/28/2018 – valid through 9/30/2023 Pending – no program changes
MS Mississippi Family Planning Waiver Extension Approved 12/28/17 – valid through 12/31/2027 Extends eligibility for family planning services to women and men, ages 13 through 44, with income at or below 194 percent of the federal poverty level (FPL) who are not enrolled in Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), or other credible health insurance coverage that includes family planning services.  This includes women who are losing Medicaid pregnancy coverage at the expiration of the 60-day postpartum period.
MS Mississippi Medicaid Work Force Training initiative New/revised  – January 15, 2018 Complete 1/21/18 Seeks to implement workforce training activities for non-disabled adults currently covered under traditional Medicaid. Would require 20 hours a week of work, training, volunteering, treatment programs, or compliance with SNAP and TANF work requirements. Aims to implement work requirements and garner additional funding for employment training.
MO Missouri Gateway to Better Health Amendment – Aug. 31, 2018- approved 1/31/19- valid through 12/31/2022 Seeks to cover office visits and generic prescriptions for substance use treatment. Also wants to expressly clarify that it is not required to seek rebates from manufacturers for drugs covered through the Gateway program. Amendment authorizes MO to provide screening, evaluation, and assessment, medication assisted treatment, psychotherapy, group therapy, peer support services, and case management services for SUD treatment to the Gateway to Better Health Demonstration population.
MT Montana Additional Services and Populations (formerly Montana Basic Medicaid for Able Bodied Adults) Extension Approved 12/14/17 -valid through 12/31/2022 No substantial changes. Aids continuing access to coverage for low-income individuals with severe disabling mental illness, and providing continuity of coverage for Medicaid beneficiaries
MT Montana Health and Economic Partnership (HELP) Program Amendment Approved 12/20/17 – Valid through 12/30/2020  Beneficiary out of pocket expenditures, including premiums, will not exceed 5 percent of household income. This amendment removes reference to the third party administrator (TPA) from the special terms and conditions (STC) to reflect changes to the state’s delivery system, and also removes the current copay structure that credited beneficiaries’ premiums toward their cost sharing obligations.  Beneficiary out of pocket expenditures, including premiums, will not exceed 5 percent of household income.
MT Montana Plan First Extension –  filed 05/11/2018 Temporary Extension granted 11/30/18, extension granted 3/29/19- valid through 12/31/2028 No substantial program changes, asks for a 5 year extension
NE Nebraska Substance Use Disorder Section 1115 Demonstration New – 11/26/18 Complete application – 12/5/18 Requests to allow Institutions for Mental Diseases (IMDs) to provide residential substance use disorder treatment services to Medicaid beneficiaries enrolled in Nebraska’s Heritage Health managed care program.
NH Granite Advantage Health Care Program (formerly New Hampshire Health Protection Program Premium Assistance) Amendment – 11/02/2017 Approved Extension / Amendment 08/02/2018 Approved 11/29/18 Work requirements will apply to able-bodied individuals, aged 19 to 64, earning between 100 to 138% of the Federal Poverty Level. Individuals who receive coverage under expansion must log 100 hours a month of community engagement activities. The plan includes the elimination of retroactive eligibility for enrollees. This will not apply to individuals who would have been eligible at any point during the otherwise available three-month retroactive eligibility period as pregnant women (including during the 60-day post-partum period), infants under 1, or children under 19, parents or caretaker relatives, or as individuals eligible in aged, blind, or disabled eligibility groups (including those who are applying for a long-term care determination). The goal of eliminating the retroactive coverage is to encourage earlier enrollment in the program, the maintenance of insurance coverage even when healthy, and preventative care treatment. Approval worked to implement a work requirement as a condition or eligibility for the program following the passage of HB 517 (2017) and changes from SB 313 (2018). Beginning January 1, 2019, the state will eliminate its premium assistance program and beneficiaries will be transitioned to the Medicaid Care Management system and mandatorily enrolled into MCOs.
NH New Hampshire Building Capacity for Transformation Amendment – 11/5/18 – Approved 2/1/19 – valid through 12/31/2020 Previously approved program. The Amendment aims to  improve access to and the quality of behavioral health services by establishing regionally-based Integrated Delivery Networks (IDNs) that are coalitions of behavioral health and other health care and community providers working collaboratively to develop a sustainable integrated behavioral and physical health care delivery system in New Hampshire.
NH New Hampshire SUD Treatment and Recovery Access New – Filed 4/25/2018- incomplete Approved 8/3/18 – Valid through 6/30/2023 Allows for SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an Institution for Mental Diseases.
NJ New Jersey FamilyCare Comprehensive Demonstration (formerly NJ Comprehensive Waiver) Amendment – 10/13/2017 JACC Amendment Withdrawn 9/28/18 Extension of Program approved 12/21/18 Waiver amendment 8/22/18 Amendment to include the Jersey Assistance for Community Caregiving (JACC) in the waiver. JACC provides in-home services to enable an individual at risk of placement in a nursing home to remain in their home. SUD amendment to allow Medicaid payment for treatment – APPROVED Delivery System Reform Incentive Program Transition plan approved 2/13/19 Amendment filed 8/22/18 requests one time allowance for stocking and clothing to community transition benefit under the Managed Long Term Services and Supports program. Requests expedited financial approval program.
NM New Mexico Centennial Care 2.0 1115 Medicaid Demonstration (formerly New Mexico Centennial Care) Extension –  12/20/2017 Approved 12/13/2018 Proposes to reduce 3 month retroactive eligibility period for most members to a 1 month period for the 1st year of the waiver then eliminate retroactive eligibility with the start of the second year (2020). Waive the Transitional Medical Assistance requirements for Parents/caretakers. Incorporate better eligibility requirements for family planning program. Request waiver authority to cover other states former foster care youth up to age 26. Seeks to modify the Alternative Benefit Plan and provide a uniform benefit package to most Medicaid covered adults. Aims to develop buy-in premiums for dental and vision services and add additional services to current plans, including those for behavioral health and home health services. Adds additional Advance Centennial awards for health behaviors. Implement premiums for the adult population with income above 100% FPL. Charge nominal fees for missed appointments. Require copays for most members when using ED for non-emergency treatment or when demanding a non-preferred drug when equal alternative is available. Targets improvements and other modifications in the Medicaid Managed Care system in the following key areas: care coordination, benefit and delivery system refinements, payment reform, member engagement, cost sharing responsibilities, and administrative simplification. Aims to increase coordination with Native American treatment. SUD Implementation protocol plan submitted 5/21/19
NY New York Medicaid Redesign Team (formerly called Partnership Plan) Amendments: 05/18/2017 08/31/2017 05/11/2018 09/12/2018 9/12/18 Waiver – requests to implement a lock-in provision allowing managed care plans to change plans for no reason for 90 days then are locked in for a 12 month period. CMS – Sent notification that waiver amendment was complete 05/23/18 Looks to implement provisions relating to long term care plans in nursing homes. Amendment approved to allow state to exempt Mainstream Medicaid Managed Care enrollees from cost-sharing provisions, except for applicable pharmacy copays.
NC North Carolina’s Medicaid Reform Demonstration New submitted in 2016, then Amendment to new waiver December 4, 2017 Approved 10/19/18 Technical corrections approved 4/25/19 Not Approved – Carolina Care enrollees would be required to be employed or engaged in activities to promote employment, depending on the passage of legislation in the NC General Assembly. Changes could be implemented based on the transition to MCOs Not approved – Carolina Care enrollees with incomes greater than 50% FPL would be required to pay monthly premiums of 2% of income. Failure to pay within 60 days of their due date would result in disenrollment. Reenrollment allowed only after back due premiums were paid. This provision is dependent on legislation passed in the NC General assembly. GA 2015-245 and Session Law 2016-121 require NC to transition Medicaid and NC Health Choice enrollees to Medicaid Managed Care program. Approved –  allows the state to transition the state’s Medicaid program from fee-for-service (FFS) to a managed care program. As part of the transition to managed care, the state will contract with plans that target high-need Medicaid populations, including plans for beneficiaries with behavioral health (BH) and intellectual/developmental disabilities diagnoses and specialized plans for foster care youth and North Carolina former foster care youth. The state also will implement an enhanced case management and other  pilot program. SUD Implementation Plan Protocol approved 4/25/19
OH Section 1115 Demonstration Waiver for Substance Use Disorder Treatment New – filed 1/1/19 Shown Complete 1/16/19, but no further movement  Waiver for substance use disorder (SUD) inpatient and residential treatment in managed care and fee-for-service (FFS) for adults and children. Ohio also requests this Demonstration to ensure a complete American Society of Addiction Medicine (ASAM) level of care (LOCs) array is available as part of an essential continuum of care for Medicaid-enrolled individuals with opioid or other SUDs. This Demonstration waiver is requested to be effective immediately upon approval to use in Institutions for Mental Diseases (IMDs) as a Medicaid-covered setting.
OH Ohio Group VIII Work Requirement and Community Engagement Section 1115 Demonstration Waiver New – 4/30/18 Approved 5/23/19 Aims to implement work requirements in line with SNAP requirements. Would require 20 hours of work or community engagement activities a week for those ages 19 through 49
OK Oklahoma SoonerCare Extension –  01/10/2018 Amendment request – 1/17/18, CMS sent letter stating would not approve as written 4/17/18 Extension approved 8/31/18 Amendment – 12/9/18 – community engagement – pending Amendment – 2/28/19 – Health Management Program – pending Amendment – 6/3/19- Health Access Network – Pending 12/9/18 Amendment – 1. Modify the existing waiver list to add community engagement requirements for certain individuals age 19 through 50; 2. Modify the existing STCs to add Medicaid eligibility criteria to certain individuals age 19 through 50; and 3. Revise the waiver document to include evaluation criteria that measures the established hypotheses for the proposed community engagement activity requirements. On August 30, 2018, CMS approved OHCA’s request to extend the demonstrations for a five (5) year period. The renewal included an extension of the existing waivers of certain Title XIX regulations as well as updates to the expenditure authorities and the Special Terms and Conditions (STCs) in order to: (1) expand Health Access Networks (HAN) statewide; (2) incorporate technical corrections; (3) include new temporary expenditure authority to certain medical education programs; and (4) provide retroactive eligibility for pregnant women and children under age 19. The current demonstration is approved for the period of August 31, 2018 through December 31, 2023.
OR Oregon Contraceptive Care (formerly Oregon Family Planning Program) Extension last approved 8/9/16, valid through 12/31/2021 No substantive changes This demonstration, the state will cover family planning services for men and women of childbearing age who are otherwise not eligible for Medicaid or the Children’s Health Insurance Program (CHIP) and whose household income is at or below 250 percent of the Federal poverty level.
OR Oregon Health Plan Extension Last approved 1/11/17, valid through 6/30/2022 This extension  adopts a payment methodology and contracting protocol for CCOs that advances the use of value-based payments and that promotes CCO flexibility and innovation by authorizing new performance incentive payments to primary care providers under the “Patient-Centered Primary Care” medical homes and “Comprehensive Primary Care Plus” initiatives.  The extension also transitions hospital pay for performance payments into the CCO program. The Hospital Transformation Performance Program will have a transitional one year extension through June 30, 2018, during which Oregon expects that any hospital pay for performance payments will be built into the 2018 CCO contracts.  The extension expands the coordinated care model to Medicaid and Medicare dual-eligible members.  Medicare and Medicaid dually eligible individuals who choose to enroll in the Oregon Health Plan may be passively enrolled by the state into a CCO. They retain the option to opt out and return to the fee for service system at any time.  The extension maintains and strengthens important services and protections for American Indians and Alaska Natives in Oregon.  The extension maintains the services paid for under the Tribal uncompensated care (supplemental) payments while converting the program into a Medicaid benefit.
PA Pennsylvania Medicaid Coverage for Former Foster Care Youth from a Different State Amendment –  03/28/2018 Approved 6/28/18 Seeking authority to use Medicaid funds to provide services to adults residing in IMDs for short term SUD treatment. Although the amendment is sought through a waiver that applies to foster care youth, they IMD authority would apply to all Medicaid enrollees.
RI Rhode Island Comprehensive Demonstration Extension – 7/11/2018 Approved 12/19/18, valid through 9/30/2022 Approved a 5 year extension in the current program as well as approval authorizes the state to receive federal financial participation (FFP) for the continuum of services to treat addictions to opioids and other substances, including services provided to Medicaid enrollees with a substance use disorder (SUD) who are short-term residents in residential and inpatient treatment facilities that meet the definition of an Institution for Mental Diseases (IMD).
SC Transitioning to Preconception Care New – August 23, 2018, Complete 9/6/18, but no further movement Focuses on family planning and preconception care
SC South Carolina Community Engagement New – filed 5/8/2019, pending Seeks to implement community engagement requirements of 80 hours a month SC’s Community Engagement waiver proposes to cover TMA enrollees using Medicaid as premium assistance to purchase coverage in a Marketplace Qualified Health Plan for up to 24 months instead of providing direct coverage through Medicaid. Seeks to expand eligibility for parents and pregnant and postpartum women, provides a limited coverage expansion for certain childless adults experiencing homelessness, justice system involvement or need for mental health and/or SUD treatment.
SD South Dakota’s Former Foster Care Youth 1115 Waiver New – January 15, 2018 Approved – 4/30/18, valid through 5/1/2023 Would provide coverage to former foster care youth under the age of 26 from different states that now reside in SD.
SD South Dakota Career Connector New – 8/13/2018, complete as of 8/27/18 but no further movement Proposes 80 hour a month work requirements for adult Medicaid enrollees who are parents, age 19 to 59 and enrolled in the parent and other care taker relative’s eligibility group living in either Minnehaha or Pennington counties.
SD Improving American Indian Health in South Dakota New – filed 4/15/19 – pending Proposes to develop an alternative service delivery model to target access to primary care services for American Indians. Requests to reimburse FQHCs with 100% FFP for services provided to American Indians.
TN TennCare II Amendment #33 – 02/06/18- withdrawn SUD – Amendment #35 – 05/25/18 Amendment #36 – 08/10/18 Amendment #37 – 11/7/18 Amendment #38 – 12/27/18 Amendment #38 –  would require for at least 4 months out of 6 months periods, beneficiaries would log 20 hours a week of work, averaged monthly Seeks to modify the special terms and conditions governing TN’s supplemental payments to hospitals. #33 – withdrawn #35 Seeks to allow Medicaid payments for eligible individuals seeking SUD treatment at a IMD. #36 – Limits the participation of elective abortion providers in TennCare #37 –  the State proposes to add two new benefits and two new benefit groups to the ECF CHOICES program.  These new benefits are targeted to people with intellectual or developmental disabilities who also have severe co-occurring psychiatric or behavioral health needs. #39 – Withdrawn
TX Texas Healthcare Transformation and Quality Improvement Program Extension Last approved 2/14/18, valid through 9/30/2022 no substantive changes
TX Healthy Texas Women New – July 5, 2017, complete 7/5/17 but no further movement Non-pregnant Women age 15-44 who do not currently receive benefits through Medicaid that provide full benefits. Net family income at or below 200% FPL. Women age 18-44 whose Medicaid for Pregnant Women coverage period is ending will automatically be enrolled in the program if not eligible for full benefits elsewhere. Covers select treatments. Uses a fee-for-service basis. Goal is to increase access to women’s health and family planning services, including preventative health care, breast and cervical cancer services, abortion alternatives, and reduce the overall cost of publicly funded health care.
UT Utah Primary Care Network (PCN) Amendments 08/16/2017- pending 06/29/2018- pending 06/22/2018 & 2/6/19-approved As a condition of eligibility, non-exempt adults will have to enroll and complete in job training and employment, require 30 hours a week Enrollment limits for Targeted Adults without Dependent Children and a 60-month lifetime limitation on the number of months an individual can receive PCN or Medicaid. Remove presumptive eligibility for current eligibles and adults without dependent children. The ability to change eligibility criteria for he Targeted Adults without Dependent Children through State administrative rule. Seeks to apply the Early and Periodic Screening, Diagnostic and Treatment waiver for Targeted Adults with Dependent Children, and withdraw the 2016 request to add these services for Current eligibles aged 19 & 20. Expand Eligibility to adults 19-64 with 95% FPL. Increase the copay for non-emergent use for the ED for parents to $25. Effects enrollees in the PCN Network. APPROVED – Eligibility for adults without dependents, ages 19-64 that have 0% FPL and chronically homeless or in criminal justice system and need treatment for mental health or substance abuse. APPROVED – Mental health expanded to current eligible. APPROVED – SUD Program Approved- adult expansion Amendment- can provide coverage to adults with incomes up to 95% FPL, Community engagement requirements
VT Vermont Global Commitment to Health Amendment – 02/06/2018 Approved 9/27/18, valid through 12/31/2021 Allows program flexibility to fight the opioid epidemic by providing further support to individuals suffering opioid dependency and SUD. Requests a waiver on restrictions to payments to IMDs for individuals age 21 to 64.
VA Virginia GAP and ARTS Delivery System Transformation Extension & Amendment – 11/30/18 Pending Would require work or community engagement activities as a  condition of eligibility for all Medicaid enrollees between ages 19 and 64 with incomes up to 138 percent of the FPL who do not otherwise qualify for an exemption. Work requirements will increase over time. It begins at 20 hours per month for the first three months and increases to 40 hours per month six months after enrollment, 60 hours per month nine months after enrollment, and 80 hours per month 12 months after enrollment. Individuals that fail to meet requirements for 3 months in a 12 month period will have coverage suspended. Asks to 1. Continue to provide essential SUD services to all Medicaid enrollees through ARTS; 2. Maintain authority for coverage of former foster care youth who aged out of foster care in another state; 3. Implement a work and community engagement program for certain adult populations; 4. Effectuate a Health and Wellness program that includes premiums and cost-sharing designed to promote healthy behavior for certain adult populations between 100 and 138 percent of the federal poverty level; and 5. Create a new housing and employment supports benefit for high-need populations.
VA Virginia FAMIS MOMS and FAMIS Select Extension – Last approved 6/24/16 Extension filed 4/25/19- pending No Substantive changes Program extends authority for 2 programs 1) the FAMIS MOMS program provides State plan coverage to uninsured pregnant women with family income from 143 percent of the federal poverty level (FPL) up to and including 200 percent of the FPL, including those pregnant women who are lawfully residing in the United States and those with access to state employee’s health benefit coverage; and, 2) the FAMIS Select program provides a premium assistance subsidy for individual or employer sponsored insurance coverage for children with family income from 143 percent up to and including  200 percent of the FPL, who are eligible for Virginia’s title XXI separate Children’s Health Insurance Program (CHIP) but choose premium assistance.
VA Virginia Delivery System Transformation Section 1115 Demonstration New – 01/18/2016 , complete 1/28/16, but no further movement Seeks to implement 2 initiatives: 1) Medicaid Managed Long Term Services and Supports, and 2) the Delivery System Reform Incentive Payment Program.
WA Washington Family Planning Only Program Extension – Approved 5/9/18, valid through 6/30/2023 No substantive Changes Program extends eligibility for family planning services to uninsured women and men capable of producing children with income at or below 260 percent of the federal poverty level (FPL); women losing Medicaid pregnancy coverage at the conclusion of the 60-day postpartum period; and teens and domestic violence victims who need confidential family planning services and have individual income at or below 260 percent of the FPL.
WA Washington Medicaid Transformation Project Amendment – 03/13/2018 Approved 7/17/18, valid through 12/32/2021 Requests flexibility to respond to the opioid crisis by allowing the provision of care to individuals with SUD for inpatient treatment.
WV West Virginia Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorder New – 12/5/16 Approved 10/10/17, valid through 12/31/2022 Authorizes WV to strengthen its SUD delivery system to improve care.
WI Wisconsin BadgerCare Reform Extension – January 21, 2018 Approved 10/31/18, valid through 12/31/2023 The waiver requires enrollees in to work or participate in community engagement activities, including job training, community service, or work programs, for 80 hours month to maintain their eligibility. The requirements apply to childless, non-pregnant, non-disabled adults, ages 18 to 49, with incomes up to and including 100% FPL. If enrollees fail to meet the work requirements for 48 months in a row, they will be locked out of Medicaid for at least 6 months. The waiver also requires individuals with incomes from 50% to 100% FPL to pay monthly premiums of up to $8. The state may vary the premiums based on responses on a health risk assessment, awarding lower premiums to those who engage in healthier behaviors, such as not smoking and maintaining a healthy weight. Completion of the health risk assessment will be a condition of eligibility and part of the application for the program. Additionally, $8 co-payments will be charged for non-emergency use of the emergency department. A substance use disorder program will also be made available to all Wisconsin Medicaid beneficiaries through the waiver. The program is designed to provide a wide array of assistance to those struggling with drug abuse and opioid use disorders. It will include the coverage of short-term residential services in facilities that qualify as institutions for mental diseases. The BadgerCare Reform waiver included a highly controversial provision to drug test all Medicaid beneficiaries as a requirement for eligibility, however this provision was not approved by CMS.
WI Wisconsin Senior Care Extension – June 15, 2018 Temporary Extension 11/28/18, approved 4/12/19, valid through 12/31/28 No program changes
WY Wyoming Medical Tribal Uncompensated Care Section 1115 Demonstration New – 01/18/16, follow-up letter stating can’t meet request from CMS on 3/6/18 Seeks to obtain federal funding for Tribal treatments. Letter from CMS dated 3/5/18 that states the plan will not be approved as written. Letter 5/6/18 states not able to provide 100% matching federal funds for costs since matching only applies to services provided through Indian Health Services.
WY WY Pregnant by Choice Extension Last approved 12/4/17 – Temporary extension granted 12/30/18, valid through 12/31/2019. No substantive changes The state will provide family planning and family planning-related services to women ages 19 through 44 with family incomes up to 159 percent of the federal poverty level (FPL) who lose Medicaid through the Wyoming Medicaid Pregnant Woman Program.

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