A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing. 2. Medicaid Eligibility and Enrollment

07/23/2014

Medicaid programs are partnerships between each state and the Federal Government, with each paying part of the cost. Some states involve counties in the partnership as well, with counties paying all or part of the nonfederal share for some Medicaid-covered services. Each state must develop a Medicaid state plan that describes the populations eligible for the program and the benefits its program will provide, and must have this plan approved by CMS.

Though every Medicaid state plan is different, federal law and CMS regulations prescribe a core set of benefits that each state must provide.10 States may decide to cover additional optional services and may limit eligibility for some of these additional services to specific groups of people.11 Medicaid state plan provisions specify many program details, including provider qualifications, definitions of covered services, target populations, and payment mechanisms for covered benefits. The innovations described in this and later chapters have focused on using, and if needed modifying and expanding, these elements of Medicaid state plans to increase access to and coordination of services for people who are or have been experiencing chronic homelessness. States must obtain CMS approval for optional services and other program details through SPAs.

Federal law also allows states to seek waivers of certain Medicaid rules and regulations. Several kinds of waivers are authorized under federal law.12 The primary waiver that some states have used to expand eligibility is the Section 1115 Research and Demonstration waiver. States may apply for a waiver under this authority to obtain program flexibility to test new approaches to financing and delivering Medicaid. In the years since passage of the Affordable Care Act in 2010, some states have expanded Medicaid eligibility with an 1115 waiver for people who otherwise were not eligible before passage of the Affordable Care Act. Some states have also obtained waivers under various provisions of Section 1915 to expand services for specific groups of beneficiaries or to give themselves flexibility to use proceeds from money-saving practices to cover services not specifically included in their Medicaid state plans. Waivers that include provisions to expand coverage also often include other provisions to implement changes in Medicaid payment and delivery systems through managed care.

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