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What is a Medicaid Waiver?

Medicaid waivers are designed to allow states to be more flexible in providing health care options to their citizens.
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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 01 December 2014
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Under the Social Security Act, several sections allow states to waive government-mandated requirements which pertain to Medicaid under certain circumstances. When a state uses this tool, it is known as a “Medicaid waiver.” Medicaid waivers are designed to allow states to be more flexible in providing health care options to their citizens, allowing states to save money and patients to have more freedom of choice. Sections 1115, 1915(b), and 1915(c) all contain specific information about different types of Medicaid waivers and how they work.

For consumers, the most important type of waiver is the 1915(c). This type of Medicaid waiver promotes the use of community-based services as an alternative to institution. If a patient is deemed suitable for institutionalization due to psychiatric illness, developmental disability, or chronic disease, the patient or the patient's advocates can request a 1915(c) waiver to get access to community-based care, allowing the patient to remain at home rather then needing to reside in an institution.

If the application for the waiver is approved, the patient will have access to home health care and other health care services which originate in the community. Medicaid may pay the patient an allowance to cover his or her medical care, or it may pay specific providers, depending on the state and the situation.

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Patients often benefit from a 1915(c) Medicaid waiver, because the waiver allows patients to select their own health care providers and it empowers patients to make choices about where and when they receive care. Advocates for people with developmental disabilities in particular have taken advantage of the Medicaid waiver program to encourage community-based care for people who would otherwise be kept in institutions, arguing that staying in the community is better for the patient. Medicaid waivers also allow people to receive skilled nursing at home, and provide access to other services which would normally be limited under the Medicaid statutes.

A 1115 Medicaid waiver allows states to waive the rules for demonstration and pilot studies. These waivers are provided on the grounds that additional research and the development of advanced health care techniques can give patients access to better care, and possibly save money in the long term by creating alternatives to traditional care. 1915(b) waivers are used by states to limit freedom of choice, allowing states to enroll patients in special managed care programs which may not be available across the state and thereby creating a situation in which patients can have access to special services. 1915(b) and 1915(c) waivers are sometimes used together to create more services and options for patients.

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betterment
Post 3

I had no idea that Medicaid patients would need to fill out a Medicaid waiver form in order to participate in a demonstration or study. I know that sometimes the only way patients can get access to some treatments is to take part in a study or clinical trial. I would figure the people who run Medicaid would be all for that, because usually the drugs are free if you're in a clinical trial.

So I'm pretty surprised they make people get a waiver to participate in something like that, because it seems like it would save money in the long run.

starrynight
Post 2

@dautsun - Speaking as someone who has witnessed a few older relatives go into nursing homes, I think most older people are happier if they can stay in their own home. However, that isn't always an option, and not just because they're on Medicaid or Medicare. Once you get to a certain point in an illness, being cared for in your home isn't always the best thing.

Anyway, I have to wonder how easy it really is to get one of these waivers approved. I've heard from a few of my friends that even filling out a Medicaid application can be a nightmare, so I imagine trying to get a waiver is probably similar.

dautsun
Post 1

I think it's great that Medicaid waivers like this exist. For some reason, I always assumed if you were on Medicaid, you just had to go through whatever Medicaid providers you were told to, and that was the end of it.

I think these waivers are especially great when they allow people to stay in their homes instead of be institutionalized, especially in the case of older people. I think most older people would probably have better quality of life if they were able to stay at their own home rather than go to an institution.

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