Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Concurrent §1915(b) and §1915(c) Waivers


Section 1915(b) waivers are used to create mandatory managed care programs. They may not be used to offer benefits that are not included in the Medicaid State Plan, nor may they be used to expand financial eligibility for HCBS beyond State Plan eligibility levels. An exception is that a managed care plan can offer expanded or additional services with program savings. Section 1915(b) waivers provide the opportunity for states to offer to enrollees additional services paid for through savings achieved under the waiver. In order to provide these §1915(b)(3) services, CMS must approve a state’s request for authority under subsection 1915(b)(3) in conjunction with either subsection 1915(b)(1) and/or (b)(4).16

Section 1915(c) waivers do not allow capitated managed care arrangements, but have been used since the 1980s to provide home and community services not covered in the Medicaid State Plan. Thus, concurrent use of §1915(b) and §1915(c) waivers allows states to cover both State Plan services (e.g., home health, personal care, and rehabilitative services) and non-State Plan home and community services (e.g. homemaker services, adult day health services, and assistive technology) in their managed care programs’ capitation rate for individuals eligible for §1915(c) waivers. States may also include home and community services in their §1915(b) waivers as §1915(b)(3) services.

The §1915(c) authority also allows states to use institutional financial eligibility criteria, which, as discussed above, expands income eligibility criteria to 300 percent of the Federal SSI benefit; applies spousal impoverishment rules; does not deem parental income for dependent children; and allows exclusions from countable income when determining financial eligibility for services. By using these two authorities concurrently, states can create an MLTC program, as has New Mexico. See Table 8-3.

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