#10: Section 1115 Demonstration and Waiver Application

List of Frequently Requested Waivers and Expenditure Authorities

The list below represents frequently requested title XIX and XXI waivers and expenditure authorities. Please ensure that the application includes a list of the proposed waivers and authorities, as well as a description of why the State believes the specific waiver/expenditure authority is needed to operate the proposed Demonstration. This is not an exhaustive list and is meant solely to provide examples.

Title XIX Waivers

Statewideness – Section 1902(a)(1): To enable the State to operate the Demonstration on a less-than-statewide basis.

Rationale for Authority:

Proper and Efficient Administration – Section 1902(a)(4)

Rationale for Authority:

Single State Agency – Section 1902(a)(5)

Rationale for Authority:

Reasonable Promptness – Section 1902(a)(8): To enable the State to limit enrollment

Rationale for Authority:

Amount, Duration and Scope of Services – Section 1902(a)(10)(B): To enable the State to provide benefit packages to Demonstration populations that differ from the State plan benefit package.

Rationale for Authority:

Rate-Setting/Payment Methodologies – Section 1902(a)(13) and (a)(30)

Rationale for Authority:

Cost-Sharing Requirements – Section 1902(a)(14) related to provisions in section 1916: To enable the State to impose co-payments, premiums or other cost-sharing to Demonstration populations that exceed the statutory limitations.

Rationale for Authority:

Assistance for Residents when Out-of-State – Section 1902(a)(16): To enable the State to limit the provision of assistance to individuals eligible under the Demonstration when out-of-State.

Rationale for Authority:

Comparability – Section 1902(a)(17)

Rationale for Authority:

Freedom of Choice – Section 1902(a)(23)(A): To enable the State to Demonstration participants to receive benefits through certain providers.

Rationale for Authority:

Provider Agreements – Section 1902(a)(27)

Rationale for Authority:

Payment for Self-Directed Care – Section 1902(a)(32)

Rationale for Authority:

Payment Review Section - – Section 1902(a)(37)

Rationale for Authority:

Retroactive Eligibility – Section 1902(a)(34): To enable the State to waive or modify the requirement to provide medical assistance for up to three months prior to the month of application.

Rationale for Authority:

Title XXI Waivers

General Requirements, Eligibility and Outreach – Section 2102

Rationale for Authority:

Benefit Package Requirements – Section 2103

Rationale for Authority:

Cost Sharing – Section 2103(e)

Rationale for Authority:

Cost Sharing Exemption for American Indians/Alaskan Native (AI/AN) Children – Section 2102(b)(3)(D)

Rationale for Authority:

Federal Matching Payment and Family Coverage Limits – Section 2105

Rationale for Authority:

Qualified Employer Sponsored Coverage – Section 2105(c)(10)

Rationale for Authority:

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