Osmosis Data Sheet

Explain the role of waivers with CMS. How do these contribute to the development of State Medicaid Plans (SPA's)?

Answer question in 250 words or more and use 2-3 peer references. APA Style

ANSWER

When we talk about waivers usually it gives you an right not to obey certain rules that actually you had to follow in course of action. Here in case of medicaid programmes we may need to alter certain rules like area to be covered under program, type of medical service covered, eligibility of people to be served under program etc and here waivers and SAP's allows you to do so.

Each states formulates the Medicaid programmes and main aim of such programme is to provide health coverage with low or free of cost to low income families, age old persons, pregnant women, handicaps (people with disabilities ) etc. Which involves investment of large amount of money, And it is contributed by state government as well as federal government, you can expect up to 50% contribution by federal government.

Before starting any medicaid programme you have to take approval from the government and besed on fulfillment of certain requirements approval will be given. Later on if state wants to make any changes in existing medicaid programmes  it must take permission from CMS (centre for medicare and medicaid services ) and it has 2 ways to get permission

1. Waivers
2. State plan amendments (SPA's)

Working of waiver and SPA's with CMS

* waivers

In order to waive certain requirements you have to take make formal request to CMS under following categories of waivers,

• 1115 demonstrations
• 1915 (b) managed care waivers
• 1915 (c) home and community based waivers
• Combined of 1915 (b) and (c)

Waivers are approval for specific time period ( 3 to 5 years) based on type of waivers and it can be renewed.

* SPA's

When state wants to make any kind of permanent changes to medical plans it goes for amendments and you don't have any kind of categories to cover that means it can be related to type of service, eligibility to get aid, area to be covered etc.

Once it is amended it's like permanent change and no need to be cost effective but in case of waivers you should be cost effective to get approval. CMS can make request for extra information or clarification, After that you will get approval with in time period of 90 days.

So, waivers and SPA'S make medical and medicaid programmes more flexible based on requirement of state as well as society.

( Reference - www.familiesusa.org/resources/publications

  https://www.cms.gov)