Whether through analyzing social determinants, increasing engagement, or creating patient-centered approaches, it’s clear that the key to health issuers’ future success lies with the people they serve and the future of Medicaid Expansion.

The Affordable Care Act (ACA) opened the door to an improved Medicaid Managed Care system. With over 74,550,529 Medicaid and CHIP beneficiaries across the country, Medicaid programs have evolved to become highly complex, multibillion-dollar enterprises. Today, some states are implementing a wide range of initiatives to coordinate and integrate care beyond traditional care. One such method is the Section 1115 waiver, which focuses on improving care for populations with chronic and complex conditions, align payment incentives with goals, and drive accountability for quality care and coverage.

This week’s America’s Health Insurance Plan’s (AHIP) National Conferences on Medicare, Medicaid & Duals, heavily honed in on this topic. Industry thought leaders including those from the National Governors Association (NGA), National Association of Medicaid Directors (NAMD) and Anthem of Indiana discussed reinforced that CMS’ Section 1115 waivers are indeed a “hot topic.”

According to the Kaiser Family Foundation, while there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS). As of August, 7 states had approved Section 1115 waivers to implement ACA’s Medicaid expansion in ways that extend beyond the flexibility of the law; this includes Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, and New Hampshire. CMS data indicated that there are 33 states with 41 approved waivers1 and 18 states with 21 pending waivers. Most recently, Medicaid experts have indicated that Kentucky will be the next to receive approval.

1115 Waivers

Source: Kaiser Family Foundation

1115 waivers also received considerable attention during the Senate Committee on Health, Education, Labor, and Pensions’ (HELP) hearings on stabilizing the individual health insurance market. Witnesses urged that the use of 1115 waiver should preserve the market and increase savings by being combined with the saving from 1332 waivers.

Download our latest whitepaper 1115 Waivers: Key Takeaways from Indiana and Michigan for more information.

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon, Inc. or any employee thereof.

Yvonne Villante
Follow Me

Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
Follow Me