NLC Small Group Follow-up: 1115 Demonstration Waivers

After the 6th Small Group Call on June 27th, we received a question in the feedback survey about what states are doing with their Section 1115 Medicaid demonstration waivers to address health related social needs (HRSN) and social drivers of health (SDOH). This Medicaid Waiver Tracker from KFF is a comprehensive and frequently updated source on 1115 waivers: https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/

Here are a few examples pulled from the site:

California Advancing and Innovating Medi-Cal (CalAIM):

  • Targeted high-need enrollees including (but not limited to): individuals experiencing homelessness, high utilizers, and individuals with SMI or SUD
  • California has also received approval to use "in lieu of” services (or ILOS) to offer a range of health-related services through managed care

MassHealth

  • Medical respite: individuals experiencing homelessness being discharged from a hospital with unresolved acute medical issues
  • Varying HRSN services available for:
    1. ACO-enrolled individuals who meet at least one health needs-based criteria and risk factor;
    2. populations that participate in MA’s specialized community supports program (CSP) (have behavioral health needs and are either: experiencing homelessness, justice-involved and living in the community, or at-risk of eviction)
    3. pregnant individuals and families experiencing homelessness (determined eligible for housing assistance under the MA Emergency Assistance Family Shelter program);
    4. individuals experiencing homelessness who do not have access to a private bathroom for colonoscopy prep

New York Medicaid Redesign Team

  • "Level Two” services include case management, housing, nutrition, and transportation services. Beneficiaries must be enrolled in managed care and meet one or more of the following criteria (and services must be medically required): high utilizers; experiencing homelessness; enrolled in designated Health Home program; SUD, SMI, or I/DD diagnosis; pregnant individuals (up to 12 months postpartum); post-release justice involved; justice-involved youth, foster care youth; children under age 6; and children under age 18 with one or more chronic condition.
  • Requirements vary per specific HRSN service (e.g., rent / temporary housing, recuperative care, nutrition supports).

Oregon Health Plan

Populations experiencing major life transitions, including:

  • youth with special health care needs;
  • adults and youth discharged from IMDs;
  • adults and youth released from incarceration;
  • youth involved in child welfare system;
  • individuals transitioning from Medicaid-only to dual eligibility status;
  • individuals experiencing or at risk of experiencing homelessness;
  • individuals with high-risk clinical needs residing in regions experiencing extreme weather events

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