Section 1115 waivers may improve care and reduce costs without increasing federal Medicaid expenditures.
In a country as large as the United States, there's no one-size-fits-all approach to meeting the healthcare needs of each state's population. That's why state Medicaid programs have played such a critical role in bringing together payers, providers, and regulators to mine innovative ways to connect low-income individuals and vulnerable populations with quality medical care.
And now that leaders across the healthcare spectrum are increasingly embracing the idea that clinical services must include socioeconomic supports to maximize effectiveness, Medicaid programs across the country are considering new initiatives to better address the social determinants of health (SDoH).
One of those initiatives is the Medicaid Section 1115 waiver program, a critical tool for states looking to use SDoH data as a means to unlock additional opportunities to maintain healthier behaviors and improve the quality of life for Medicaid populations. As of October 2020, there are 56 active waivers in 44 states, with another 27 requests pending review.
Why Medicaid Section 1115 waivers are so important?
For decades, Medicaid waivers have targeted broad delivery system reforms or narrower issues aimed at specific subgroups of Medicaid populations, including those focused on behavioral health, delivery system reform, and management of long-term care (MLTSS).
Section 1115 waivers empower state Medicaid programs to become more comprehensive and coordinated in how they not only prioritize socioeconomic needs but enact fundamental changes to deliver cost-effective healthcare for Medicaid populations.
How are states using Section 1115 waivers to address SDoH?
At a high level, Section 1115 waivers allow states to use Medicaid funds to directly or indirectly address key SDoH like food and housing stability, interpersonal safety, and transportation access. But how those funds are applied differs from state to state based on their specific populations' needs.
Recent success stories include:
- Rhode Island: The state's Medicaid Infrastructure Incentive Program applies infrastructure funds to initiatives that build partnerships with CBOs and develop additional capabilities for delivering services focused on SDoH.
- Washington State: Accountable Communities of Health (ACH) works closely with CBOs to flag individuals with social needs for enhanced support, such as access to care coordination, social workers, and comprehensive case management.
- North Carolina: The state's Healthy Opportunities program will provide up to $650 million in Medicaid funding for pilots designed to directly impact outcomes and spending while serving to gather evidence of the effectiveness of similar approaches.
Your guide to Section 1115 waivers and their potential impact on SDoH
Ready to dive deeper into the world of Section 1115 waivers?
Download our latest brief, Leveraging Medicaid Section 1115 Waivers to Address Social Determinants of Health, to learn more and see how state Medicaid programs across the country are using these opportunities to address SDoH.