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.
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.
- Current state spending is not affected. All General Revenue Funds used as the basis for increased federal match stays the same.
- Any future use of funds created by the 1115 waiver will be submitted to the GA and appropriated through the usual process.
- 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.
- 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:
1115 Waiver Application (HTML)
A physical copy of the waiver application is available at:
201 South Grand Avenue East
Springfield, Illinois 62763-0002
The Governor's Office and the Illinois Department of Healthcare and Family Services, in cooperation with the Department of Children and Family Services, the Department on Aging, the Department of Human Services and the Department of Public Health, is seeking a five-year Medicaid and Children's Health Insurance Program (CHIP) Section 1115 research and demonstration waiver that encompasses all services and eligible populations served under a single authority, with broad flexibility to manage the programs more efficiently and to align and coordinate programs where possible. The state expects that over the five year life of the Demonstration, aggregate expenditures will be the same as they would have been without the waiver.
Friday, February 14, 2014
9:00 AM to 12:00 PM
Michael J. Howlett Building
501 South Second Street
Springfield, IL 62756
CLICK HERE TO REGISTER
Thursday, February 20, 2014
2:00 PM to 5:00 PM
Assembly Hall Auditorium
James R. Thompson Center
100 W. Randolph Street
Chicago, IL 60601
CLICK HERE TO REGISTER
*There is a call in option for this hearing. More information is provided after registering.
Any interested party may direct comments, data, views, or arguments concerning these proposed changes. All comments not provided at the hearing must be made in writing by March 10, 2014, and should be addressed to:
Theresa Eagleson, Administrator
Division of Medical Programs
Department of Healthcare and Family Services
201 South Grand Avenue East, 3rd Floor
Springfield IL 62794
Email address: firstname.lastname@example.org
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
*EXTENDED: March 10, 2014 Written comments due
March 12, 2014 Waiver submitted to CMS
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
Medicaid Health Systems Transformation - Request for Information (Reference number: 22032626)
Center for Medicare and Medicaid Servicess Section 1115 Demonstration Page
The slides from January 9th 1115 Waiver Stakeholder Meeting are available here. The recording of the January 10th Webinar is available here.