Support: 866.543.6646
Sales: 855.489.1792

What Are Section 1115 Waivers and How Do They Affect Behavioral Health?

What Are Section 1115 Waivers and How Do They Affect Behavioral Health?

posted by: Nicole Hovey date: May 02, 2019 category: Blog comments: Comments Off on What Are Section 1115 Waivers and How Do They Affect Behavioral Health?

One main goal of the Affordable Care Act (ACA) is increased insurance coverage for low-income Americans. The ACA aimed to achieve this goal partly through the expansion of Medicaid to most U.S. adults at 138 percent of the federal poverty level.

Although there are financial incentives for adopting the Medicaid expansion, the decision is still up to individual states. As of April 2019, 36 states and the District of Columbia have adopted the Medicaid expansion. This leaves 14 states that have not expanded their Medicaid program coverage.

What Are Section 1115 Waivers?

Federal law gives individual states some flexibility in how they implement and operate their Medicaid programs. States may also apply for a Section 1115 waiver, granted by the Centers for Medicare & Medicaid Services.

Section 1115 waivers give states additional leeway to deviate from federal Medicaid guidelines and laws. States also can use the waivers to test different ways to deliver or fund Medicaid services.

Behavioral Health and Section 1115 Waivers

Many people who are currently uninsured and living at or below the federal poverty level also struggle with mental illness, addiction, or other behavioral health issues. Federal law requires all state Medicaid programs to provide some mental health services. Some state Medicaid programs provide beneficiaries with addiction treatment services.
By expanding Medicare coverage, more individuals may gain access to services to help address their behavioral health needs.
Even states that have not formally expanded Medicaid can use Section 1115 waivers to expand coverage to additional low-income residents. The mental-health organization NAMI has officially called on every state to expand Medicaid and apply for Section 1115 waivers to ensure that Medicaid programs provide “adequate mental health services and supports.”

One use for Section 1115 waivers is to improve service systems for behavioral health and addiction treatment. As of September 2017, 12 states had approved Section 1115 Medicaid waivers related to behavioral health.

How Are States Using Section 1115 Waivers?

Under new legislation, the Idaho Department of Health and Welfare has been directed to seek a Section 1115 waiver for multiple changes to the state Medicaid program. If the waivers are not approved by January 1, 2020, then all individuals at or below the federal poverty line will be enrolled in Medicaid.

One change involves adding questions about substance use disorder to the initial Health Assessment to direct beneficiaries to services early. Another change is the use of Medicaid funds directly for inpatient behavioral health and addiction treatment services.

Arizona used a waiver approved in 2016 to better integrate physical and behavioral health, including payment incentives to providers. In Delaware, a waiver allowed the state in 2015 to implement a voluntary program that provides enhanced behavioral health services for certain Medicaid beneficiaries.

Prepare for Expanded Behavioral Health Services

Behavioral health and addiction treatment providers could see an increase in demand in states that have expanded Medicaid coverage or received Section 1115 waivers. Adopting a comprehensive EHR solution can help you keep up with demand while streamlining services.

Created specifically for behavioral health professionals, BestNotes EHR offers the features you need to improve patient care, increase practice revenue, and reduce staff frustration. Contact us today to learn more about our solutions, or to schedule a free demonstration.

Comments are closed.