Medicaid waivers give states the flexibility to design healthcare programs that better serve their residents. Two key types of waivers, 1915(a) and 1915(b), allow states to manage how Medicaid recipients receive care, with one focusing on voluntary managed care and the other on mandatory managed care.
Ahead, we explore how these waivers work, using real examples to illustrate their impact.
Managed care helps states deliver Medicaid services in a more organized and cost-effective way. Instead of Medicaid paying for each individual service separately, managed care plans allow states to pay a set amount to a health plan, which then provides all the necessary healthcare services to Medicaid recipients.
States use waivers like 1915(a) and 1915(b) to create and manage their Medicaid programs. These waivers give states flexibility to set up managed care systems that work best for their residents. Whether the state wants to offer voluntary managed care (1915(a)) or make it mandatory (1915(b)), these waivers allow them to tailor Medicaid services while maintaining oversight from the federal government.
A 1915(a) waiver allows states to set up a voluntary managed care program for people on Medicaid. This means Medicaid recipients can choose to join a managed care plan but aren’t required to.
Unlike other types of waivers, the state doesn’t need a formal federal waiver to start this program. However, they still need approval from the Centers for Medicare and Medicaid Services (CMS), the government agency that oversees Medicaid.
By using this waiver, states can offer more choices without forcing anyone to switch to a managed care plan.
A 1915(b) waiver lets states require people on Medicaid to join a managed care plan. This means Medicaid recipients must get their healthcare through a specific network of doctors, hospitals, and providers instead of having complete freedom to choose any provider.
These waivers help states save money and improve how Medicaid services are delivered. States must get approval from the Centers for Medicare and Medicaid Services (CMS), and the waiver needs to be renewed every two years.
This waiver helps states manage care more efficiently, but it also means that Medicaid recipients have fewer choices regarding their healthcare providers.
Different states use 1915(a) and 1915(b) waivers to meet their Medicaid needs. Here are a few examples:
The Texas Medically Dependent Children Program (MDCP) Waiver is an example of how a 1915(a) waiver works. It allows Texas to offer voluntary managed care to medically fragile children, meaning families can choose to receive home-based services instead of institutional care and receive a range of supports like respite care, employment assistance, and adaptive aids. This waiver operates alongside an 1115 waiver, which gives the state more flexibility to experiment with innovative ways of delivering care and improving outcomes. Combining these waivers allows Texas to provide more personalized and cost-effective care while maintaining oversight and flexibility.
CalAIM helps people get care through managed care plans, which means the state assigns them a network of doctors and hospitals. CalAIM also focuses on providing services beyond regular healthcare, like housing support for people who are homeless. This has helped California control Medicaid costs while making sure that recipients still have access to essential healthcare services.
If your state offers a 1915(a) waiver, you have the option to participate in a managed care plan, but it’s not required. Here’s how you can get involved:
We know that navigating Medicaid programs can be challenging for families and caregivers. Our goal is to give you clear, easy-to-understand information that helps you make smart choices about the care you or your loved ones get.
