Sec. 1932(a) State Plan |
Sec. 1915(b) Waivers |
Sec. 1915(b)(c)Combo Waivers |
Sec. 1115 Demo/Waivers |
|
---|---|---|---|---|
General Authority |
Exempts states from these statutory requirements: * Statewideness * Comparability * Freedom of choice |
Waives state plan requirements for: * Statewideness * Comparability * Freedom of choice Allows state to provide “other” services” and limits number/types of providers |
Same as Sec. 1915(b), but permits reimbursement for non-Medicaid services necessary to allow people to live in home and community settings |
Supports all of the waivers permitted under Sec. 1915(b) & (c) plus the waiver of other Sec. 1902 requirements. Also permits federal matching for non-Medicaid funded services |
Approval Period |
Indefinite |
Initial 3-year period + indefinite 5-year renewals |
Same as Sec. 1915(b) |
Initial 5-year period, subject to renewal |
Mandatory Enrollment Target Populations |
All state plan populations except children with special needs, American Indians, and Medicare beneficiaries |
All state plan populations |
All state plan populations |
All state plan populations plus designated groups not otherwise eligible for Medicaid benefits |
Application Requirements |
Completion of state plan amendment preprint |
Completion of CMS application template |
Same as Sec. 1915(b) |
Submit proposal describing key program features |
Fed. Budget Requirements |
No budget/cost analysis required |
Demonstrate cost-effectiveness |
Same as Sec. 1915(b) |
Demonstrate budget neutrality |
CMS Review Timeframe |
Approval within 90 days unless disapproved or CMS requests additional info. Request must be approved or disapproved by CMS within 90 days of receipt of additional info. |
Same as Sec. 1932(a) state plan amendments |
Same as Sec. 1932(a) state plan amendments |
No required timeframe for CMS review or approval |
Renewal Period |
No renewal required |
After 3 years for initial waiver requests and after 5 years for all subsequent requests |
Same as Sec. 1915(b) waiver requests |
Customarily up to 3 years, but CMS may approve a 5-year period if dual eligibles are being enrolled |
Program Documentation |
Contained within CMS state plan preprint |
Contained within CMS application template |
Contained within CMS application template |
Special terms and conditions negotiated between CMS and the state |
Monitoring/ |
CMS monitors implementation of the State Plan Amendment to ensure that requirements are met. State required to conduct separate evaluations of managed care entities |
CMS monitors implementation of waiver to ensure that requirements are met. State required to conduct separate evaluations of managed care entities |
Same as for Sec. 1915(b) waivers |
CMS monitors implementation of the waiver to ensure that requirements are met. Periodic external evaluations also required |
Appendix E. Characteristics of Statutory Authorities: Medicaid Managed Care
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