GenIC #10 (Extension w/o change): Section 1115 Demonstration and Waiver Application

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

10 - List of Waivers and Expenditure Authorities_ 6 28 12m

GenIC #10 (Extension w/o change): Section 1115 Demonstration and Waiver Application

OMB: 0938-1148

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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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