Waivers

Waivers allow states to set aside certain Medicaid and Children’s Health Insurance Program (CHIP) statutory or regulatory provisions in order to test innovative strategies or policies for delivering or financing care more cost-effectively. Waivers are powerful tools. They enable states to transform programs, improve quality of care, and expand coverage, while simultaneously preserving or increasing federal financial contributions to their state health care systems.

The Center for Health Law and Economics at UMass Medical School has significant experience in designing and implementing Medicaid and CHIP waiver programs. Our legal experts can also negotiate with the Centers for Medicare & Medicaid Services to obtain federal waiver approvals for proposed policy and program changes.

With deep knowledge of Medicaid and CHIP law, as well as long-term experience overseeing state Medicaid waiver programs, we are able to assist public sector health agencies in obtaining the necessary federal approvals as quickly as possible. The Center for Health Law and Economics at UMass Medical School works as a partner with agencies, managing the waiver process from start to finish and aggressively representing the agency at each step of the way.

Our waiver services include the following:

  • Designing comprehensive or discrete waiver programs
  • Drafting all waiver documents, including waiver proposals and amendments
  • Assessing strategies for obtaining necessary and timely federal approvals
  • Providing multi-state analyses to determine precedence for waiver requests
  • Communicating directly with federal officials
  • Representing public sector health agencies in negotiations with federal officials
  • Responding to regulator questions and requests for additional information
  • Interpreting complex waiver documents for stakeholders
  • Developing stakeholder communication strategies
  • Advising states on how best to implement and finance waiver programs

1115 and 1915(c) Waivers

The Center for Health Law and Economics provides a full range of services for Section 1115 waivers and Section
1915(c) waivers:

Section 1115 Research and Demonstration waivers allow states to comprehensively restructure their Medicaid or CHIP programs — or test discrete policies or strategies for delivering or financing care in a more cost-effective manner. The Center for Health Law and Economics at UMass Medical School works with public sector agencies to manage all aspects of the waiver process. Our staff provides consulting on the following:

  • Streamlining of eligibility processes
  • Reform of the long-term care system
  • Expansion of coverage to new populations or for new services
  • Implementation of innovative care delivery models

Section 1915(c) waivers allow states to expand access to Medicaid-covered home- and community-based long-term supports to elders and individuals with disabilities who might otherwise require institutional care. As the numbers of individuals who need or will need long-term supports grows, more states are aligning policies and programs with consumers’ needs and preferences. They are also expanding access to quality home- and community-based supports. The Center for Health Law and Economics at UMass Medical School works with public sector agencies throughout the 1915(c) waiver process by offering a broad range of services.