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1115(a) | 1915(c) | 1915(b)(4)

1115(a) summary:

42 C.F.R. § 431.400

Section 1115 of the Social Security Act allows the Secretary of the Department of Health and Human Services (HHS) to waive certain federal requirements and gives the Centers for Medicare and Medicaid Services (CMS) the authority to approve experimental, pilot, or demonstration projects. The purpose of these waivers is to demonstrate and evaluate policy approaches to better serve the Medicaid population. These projects must be likely to assist in promoting the objectives of the Medicaid program as determined by the Secretary.

1115(a) demonstrations must be “budget neutral,” meaning that during the course of the waiver the Division of Medicaid expenditures cannot exceed what they would be without the waiver.

1915(c) summary:

42 C.F.R. § 430.25 Waivers of State Plan Requirements

A waiver under Section 1915(c) of the Social Security Act allows the Division of Medicaid to provide home and community-based services to beneficiaries who would otherwise need institutional care that is furnished in a hospital, Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), or Intermediate Care Facility for Individuals with Intellectual Disability (ICF/IID). Section 1915(c) of the Social Security Act was enacted to enable states to address the needs of individuals who would otherwise receive costly institutional care by providing cost-effective services to assist them to remain in their homes and communities. The Division of Medicaid has the following 1915(c) waivers:

  • Traumatic Brain Injury/Spiral Cord Injury (TBI/SCI) Waiver provides case management, personal care attendant, respite, environmental accessibility adaptations, specialized medical equipment and supplies, transition assistance services for individuals with a diagnosis of traumatic brain or spinal cord injury and be medically stable.
  • Assisted Living (AL) Waiver provides personal care, supervision, therapeutic care and social services in a home and community-based setting as opposed to an institutional setting. Waiver participants reside in a Personal Care Home-Assisted Living facility that is licensed by the Mississippi State Department of Health or other licensed adult residential care home/community living setting as deemed acceptable by the Division of Medicaid. Participants must meet the nursing facility level of care.
  • Intellectual Disabilities/Developmentally Disabled (ID/DD) Waiver provides day services-adults, in-home respite, prevocational services, supervised living, support coordination, supported employment, supported living, specialized medical supplies, therapy services, behavior support services, community respite, crisis intervention, crisis support, home and community supports, host home, in-home nursing respite, job discovery, shared supported living, transition assistance for individuals for those with autism, intellectual or developmental disabilities.
  • Independent Living (IL) Waiver provides case management, personal care attendant (PCA), environmental accessibility adaptations, specialized medical equipment and supplies, transition assistance services for aged individuals who have severe orthopedic and/or neurological impairments. Individuals must also be medically stable and be able to express ideas and wants either verbally or nonverbally with caregivers, personal care attendants, case managers, or others involved in their care.
  • Elderly and Disabled (E&D) Waiver provides adult day care, case management, in-home respite, personal care service, extended home health services, community transition services, home delivered meals, institutional respite care, physical therapy services, speech therapy services for aged individuals who require nursing facility level of care if assistance is not provided.

1915(b)(4) summary:

Section 1915(b) of the Social Security Act gives the Secretary of Health and Human Services the discretion to waive a broad range of requirements included in Section 1902 of the Act as may be necessary to implement alternative delivery mechanisms for its Medicaid program. This enables the Division of Medicaid to restrict the provider from whom Medicaid beneficiaries receive services as long as such restrictions do not substantially impair access to services of adequate quality where medically necessary. The Division of Medicaid’s 1915(b)(4) waivers are specifically for selective contracting arrangements that are paid on a fee-for-service basis.

Currently, the Division of Medicaid has 1915(b)(4) waivers to run concurrent with the 1915(c) waivers as follows: