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1115 Waiver 

1115 Waiver Update

In the interest of keeping stakeholders informed of the status of Illinois’ 1115 Waiver application, the state committed to providing periodic updates via the health care reform website and public meetings.  This update provides a summary of waiver negotiations with the Centers for Medicare and Medicaid Services (CMS) since the last update provided at the Health Care Reform Implementation Council meeting on June 4, 2014. 

June
The Medicaid 1115 Path to Transformation Waiver was submitted to the Centers for Medicare and Medicaid Services on June 4, 2014.  CMS had 30 days to officially accept the waiver submission, which they did on July 3, 2014. 

July
Once the waiver was officially accepted by CMS a coordinator was assigned to help facilitate waiver negotiations and calls were scheduled to begin going through the details of the waiver application.  CMS requested an Executive Summary of the waiver, specifically asking that it provide an overview of the need for the waiver as well as a “before” and “after” picture of what the state wants to accomplish through the waiver.  The Executive Summary can be viewed here

The initial conversations with CMS also included discussion about what components of Illinois’ application should be pursued through SPA authority vs. 1115 waiver authority vs. a global 1915(c).   This question applies throughout the waiver application and therefore has been defer="defer"red.

August & September
In August CMS committed to a bi-weekly meeting schedule toward a goal of completing waiver review by the end of the 2014 calendar year.   The August and September meetings were spent going through the requested Executive Summary and answering CMS questions on the Costs Not Otherwise Matchable (CNOM) worksheets. 

October
The State and CMS recently began discussions on the Budget Neutrality component of the waiver.  This entails comparing the “with waiver” and “without waiver” cost and savings estimates against possible trend rates.  
              

Background

Building on the work of the Alliance for Health the State of Illinois is launching an effort to develop a Path to Transformation Medicaid Waiver under the Centers for Medicare and Medicaid Services waiver authority, Section 1115 of the Social Security Act.  This section gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs and that differ from federal program rules. The purpose of these demonstrations, which give States additional flexibility to design and improve their programs, is to demonstrate and evaluate policy approaches such as:

  • Expanding eligibility to individuals who are not otherwise Medicaid or CHIP eligible
  • Providing services not typically covered by Medicaid such as supportive housing
  • Using innovative service delivery systems that improve care, increase efficiency, and reduce costs.

Waivers are generally approved for five years and must result in federal expenditures that are less than or equal to what would have been spent in the absence of the waiver.  As we look to establish a more integrated, rational, and efficient healthcare delivery system, we need input from stakeholders to help shape the goals and key strategies of the waiver. 

The Illinois Department of Healthcare and Family Services will submit the waiver application to the federal government. More information is available on the Department of Healthcare and Family Services webpage.

This FAQ is available for more information on the Illinois waiver application.

1115 Waiver Application

The waiver application posted below is targeted specifically to issues of concern to federal Centers for Medicare and Medicaid Services (CMS).  The state’s application must describe specific changes to Medicaid for which federal approval is needed and lay out the basis for our request for substantial new federal resources to make program changes intended to save costs over the next five years. It is not intended as a general description of how the Illinois Medicaid program will function if CMS approves the waiver.

Governor Quinn is committed to a broad, transparent process to develop the specific policy and program changes to implement the waiver. The waiver points us in a new direction. The details of how we get there and what it looks like when we do will be developed over the next six to 12 months together with stakeholders.

The state received numerous concerns and comments in response to the draft waiver posted in January. Each one was carefully considered by the state and the Health and Medicine Policy Research Group consulting team.  We have incorporated many of them into the revised waiver application. But many concerns were related to the implementation phase. Here are some specific guidelines that may help explain the waiver application. 
  1. Current state spending is not affected. All General Revenue Funds used as the basis for increased federal match stays the same.
  2. Any future use of funds created by the 1115 waiver will be submitted to the GA and appropriated through the usual process.
  3. The waiver will not take effect for at least six months after submission, possibly up to a year. For a proposal of this magnitude, negotiations will be lengthy. The governor’s FY 2015 budget will not reflect any of the reinvestments anticipated once the waiver is approved.
  4. A companion document explaining how this document, the Alliance for Health Innovation Plan, and plans for the implementation discussions will be available soon.

Read the application:

SUBMITTED APPLICATION: 1115 Waiver Application
(HTML)
FAQ on 1115 Waiver Application 


A physical copy of the waiver application is available at:
201 South Grand Avenue East
Springfield, Illinois 62763-0002 

Timeline

October 18, 2013 Stakeholder kick-off meeting
Oct. 18-Dec. 13, 2013 Stakeholder meetings
November 5, 2013 Concept paper finalized
January 8, 2014   Draft waiver posted for comment
January 22, 2014 Waiver comments due
February 10, 2014 Final waiver w/comments posted
February 14, 2014 Public Hearing in Springfield
February 20, 2014 Public Hearing in Chicago
March 2014 Earliest opportunity to submit to CMS

Resources 

1115 Waiver Kick-Off Meeting Slides
Kick-Off Meeting Attendance List
Slides from November 14, 2013
1115 Waiver Concept Paper
Public Comments on 1115 Waiver Concept Paper
Public Comments on 1115 Waiver Draft Application
Public Comments on 1115 Waiver Application - Summary of Comments and Responses
Medicaid Health Systems Transformation - Request for Information (Reference number: 22032626)
Center for Medicare and Medicaid Servicess Section 1115 Demonstration Page

Webinars

The slides from January 9th 1115 Waiver Stakeholder Meeting are available here. The recording of the January 10th Webinar is available here.