Section 1115 Waivers-Fourth Quarter Overview

 1115 Waiver Activity : 2018 Q4

We recognize that it’s difficult to stay on top of the 1115 waiver developments across the country, and we want to help by providing a quarterly snapshot of major 1115 waiver activity and decisions.

By Centauri Health Solutions Staff

With our Hospital and Health Plan audience in mind, we will focus on the following waiver initiatives that have stemmed from CMS’ encouragement to states over the past few years to develop proposals to “improve the effectiveness” of the Medicaid program:

  • Addition of community engagement (work) requirements
  • Modification or elimination of 90-day retroactive coverage
    • Federal law directs state Medicaid programs to provide 90-day retroactive coverage to give people time to apply after a traumatic incident or illness diagnosis
  • Implementation of coverage lock-outs which can immediately suspend coverage if community engagement requirements are not met.

Latest 1115 Waiver Activity – (October – December 2018)

Focused on these three initiatives, here is a look at the Q4 2018 activity:

  • Florida – On Nov. 29, the federal government approved Florida’s 1115 waiver request to change its Medicaid coverage rules, eliminating the 3-month retroactive eligibility obligation, thus lowering the state’s Medicaid program costs. The new policy allows Medicaid-eligible Florida applicants to receive up to 30 days of retroactive health care, with coverage starting the first of the month of application. This shortened coverage period will not apply to children or pregnant women.
    • Q4 ’18 Status: This went into effect on Feb. 1, 2019 and will remain in effect until June 30, 2019 unless state lawmakers agree to extend it.


  • Michigan – In October, the CMS public comment period ended for Michigan’s proposed 1115 waiver amendments to its Healthy Michigan Plan. One of several provisions in the 1115 Waiver application calls for Medicaid beneficiaries aged 19 to 62, with exceptions to participate in an 80-hour per month work/community engagement program.
    • Q4 ’18 Status: On December 20, 2018, CMS approved Michigan’s request for extension and amendment of its Medicaid demonstration project, effective January 1, 2019. Michigan will implement a community engagement requirement beginning no sooner than January 1, 2020.


  • Virginia – In December, Virginia submitted a request to CMS to extend its current 1115 waiver program, adding a community engagement program. The expanded program is retitled COMPASS (Creating Opportunities for Medicaid Participants to Achieve Self-Sufficiency). The waiver calls for increasing monthly work hours (from 20 to 80 hours) for participants in the first year, with suspension of Medicaid benefits for those who fail to comply.
    • Q4 ‘18 Status: The federal public comment period was December 7, 2018 through January 6, 2019.


  • Kentucky – In November, CMS approved a revised version of Kentucky’s HEALTH (Helping to Engage and Achieve Long Term Health) program. The new program was in response to a federal judge’s rejection of the state’s original 1115 waiver program that was set to go into effect last July – and the thousands of mostly negative comments that followed in the CMS public comment period. While most of the original waiver program remains the same, the new version removes the premium and work requirement for domestic violence victims. Among the provisions that remain from the original waiver is the elimination of 90-day retroactive coverage, with coverage only beginning the month after enrollment, and a lock-out provision that ends coverage for individuals who do not meet the 80-hour/month requirement for community engagement. The suspension, which could last the remainder of the calendar year, can be lifted if beneficiaries complete work or education requirements.
    • Q4 ‘18 Status: CMS has authorized the program to go into effect statewide on April 1, 2019. The work/community engagement portion will be rolled out in phases (beginning with Northern Kentucky) starting in April 2019.


  • Wisconsin – In October, CMS approved a wide array of Wisconsin’s requested get-tough changes to the state’s BadgerCare Medicaid program, but rejected a provision that would have required drug screening and testing for adults on Medicaid with no dependent children. The revised program implements work requirements for childless adults on Medicaid. It calls for participation in a training program, or volunteering for at least 80 hours a month to maintain coverage. Wisconsin becomes the first non-expansion state to receive CMS approval for Medicaid work requirements.
    • Q4 ’18 Status: Wisconsin Medicaid will work for at least one year from October 31, 2018, to put these new policies in place. DHS will work with members, providers, partners, and other stakeholders across the state to get valuable input, suggestions and feedback to help build the implementation plan. Members will receive notice of any changes that may affect them before Wisconsin Medicaid makes any changes.


  • New Hampshire – In December, in approving an extension of New Hampshire’s May-approved waiver program, CMS made changes to it without consulting the state. The new waiver prevents Medicaid recipients from making up a shortage of monthly work hours at a later date and eliminates 90-day retroactive coverage for the new adult group. The original waiver already included some of the nation’s toughest provisions of community engagement demonstrations, requiring beneficiaries to report at least 100 hours per month of work, job training, education or volunteer activities compared to 80 hours in other states. Recipients also face suspension from Medicaid the month after failing to report the required level of community engagement activities, versus repeated months of non-compliance in other states.
      • Q4 ’18 Status: State Democratic lawmakers vow to work with the Republican governor to try to renegotiate the waiver with CMS. The state was authorized to begin implementation of the community engagement requirement and the enrollment of eligible beneficiaries into Medicaid managed care as of January 1, 2019.


  • Oklahoma – Oklahoma applied for a waiver to add community engagement requirements for certain adults to receive Medicaid.
    • Q4 ’18 Status: The federal public comment period on this proposed waiver opened on December 20 and ended on January 18, 2019.


  • Tennessee – Tennessee has also officially proposed to add community engagement requirements for certain individuals aged 19 to 64 who are enrolled in the parent/caretaker relative Medicaid eligibility group.
    • Q4 ’18 Status: The federal public comment period opened on January 8, 2019 and will end on February 7.


Q1 2019 Update
Watch for our next blog at the start of the second quarter, recapping key Q1 activity.