MACPAC votes to urge Congress to streamline Medicaid waiver process
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A panel that advises Congress wants to make it easier for states to get Medicaid waivers.
The Medicaid and CHIP Payment and Access Commission on Thursday voted unanimously to suggest that Congress extend approval and renewal periods for 1915(b) waivers from two to five years.
It also voted to streamline the 1915(b) and 1915(c) waiver requirements so states seeking both waivers could use one application.
"We're trying to do some administrative simplification here," said Alan Weil, editor in chief of Health Affairs and MACPAC commissioner. "It doesn't help to have these administrative hurdles."
Both recommendations will be in the commission's annual report that will be presented to Congress in March.
The 1115 waivers tend to be the best known because they offer the most flexibility to conduct experiments. There are 22 states with 1115 waivers today. But 1915 waivers are also widely used, with more than 60 such waivers in effect across the country. The 1915(b) waivers can be used to implement managed care or launch special programs like those that target behavioral health. The 1915(c) waivers can be used to launch and maintain home and community-based care programs.
Allowing five-year 1915(b) waivers would reduce the administrative burden for states and the federal government, according to MACPAC. The change would also given them the same duration as 1115 waivers.
States with 1915(c) waivers that have created home and community health programs currently have to also apply for a 1915(b) waiver to allow selective contracting and waive freedom of choice. Under the current waiver rules, that could mean a state has to file two applications with different requirements and timelines. MACPAC's proposal would reduce the burden associated with applying for two waivers.
The CMS could not, on its own, allow states to do either of these things which is why the recommendations are targeted at Congress. Historically, Congress has not followed MACPAC's recommendations as much as they do suggestions made by the Medicare Payment Advisory Commission. The concern was that commission members were left leaning.
MACPAC is now considered more moderate, following the recent appointment of Darin Gordon, the former Medicaid director of Tennessee.
Correction: An earlier version of this story inaccurately described MACPAC's recommendations. The error has been corrected.
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