Wonky Word Wednesdays: 1115 Waiver

The tabling of the Healthy Montana Plan HB249 on March 6th without debate or amendments was a sad day for the 70,000 Montanans still waiting for healthcare coverage and for the 250 proponents who came to Helena to testify. However, it is not the end of Medicaid expansion. There is still time in this legislative session to get this done. In fact, yesterday Republican Senator Ed Buttrey introduced Senate Bill 405 which aims to cover the same individuals without access to affordable health care coverage, but also proposes premiums and copayments that were not included in HB249.

We are encouraged that legislators from both parties are willing to work together to find a solution. Medicaid expansion is too important to our citizens, our economy, and our rural hospitals to give up.

But regardless of what legislation passes going forward, Montana will have to apply for an 1115 waiver to expand coverage and receive the additional federal funds. So lets begin our Wonky Word Wednesday and see what this 1115 waiver is all about!

Simply put, 1115 waivers provide states the flexibility to test new or existing ways of financing and delivering Medicaid and the Children’s Health Insurance Program (CHIP). 1115 waivers are submitted by a state to the federal Center for Medicaid and Medicare Services (CMS). If approved, the federal government will cover costs not typically covered under Medicaid and can waive certain program requirements, like expanding eligibility.

While a waiver provides some flexibility to states, CMS requires that the waiver must promote the objectives of Medicaid, namely, to keep low-income families healthy. For example, the federal government has made it clear it will not approve a waiver that limits the number of eligible people who can be enrolled under the plan. The waiver must also show that the plan will not cost the federal government more than straight expansion would.

So far, 28 states have expanded Medicaid and five have done so through 1115 waivers. 1115 waiver approval in Michigan resulted in over 400,000 more individuals receiving healthcare coverage and 200,000 individuals in Arkansas.

Providing Montanans health care coverage is a vital move for Montana‘s economy and its communities. While straightforward Medicaid Expansion is probably a better way to cover Montanans, an 1115 Medicaid waiver is a viable option to enable Montana to craft an expansion plan to provide quality health care coverage to Montanans who currently cannot afford health insurance. It also will bring millions into our state to help our economy, create jobs, and save hospitals millions in uncompensated care.

Learn more about 1115 waivers through these sites:

Medicaid Expansion Waivers: Providing Options, Protecting Montanans

Section 1115 Demonstrations

States that have applied for waivers and details

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