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1915(b) FREEDOM OF CHOICE WAIVERS
PURPOSE: Section 1915(b) of the Social Security Act provides "the Secretary may . . . waive such requirements of section 1902(other than subsection (s)(other than sections 1902(a) (13)(E) and 1902(a)(10)(A) insofar as it requires provision of care and services described in section 1905(a)(2)(C))."
FEATURES
1. GENERAL FEATURES: States are permitted to waive
statewideness, comparability of services, and freedom
of choice. 1915(b) waivers are limited in that they apply to
existing Medicaid eligible beneficiaries, authority under this waiver
can not be used for eligibility expansions. There are four 1915(b)
Freedom of Choice Waivers:
(b)(1) mandates Medicaid Enrollment into managed care
(b)(2) utilize a "central broker"
(b)(3) uses cost savings to provide additional services
(b)(4) limits number of providers for services
2. WHY A 1915(b) WAIVER?
In order to:
*Mandatorily enroll beneficiaries into managed care programs, although States have the option, through the Balanced Budget Act of 1997 to enroll certain beneficiaries into mandatory managed care via a State Plan Amendment.
*Create a "carveout" delivery system for specialty care-for example: Managed Behavioral Health Care Plan
*Create programs that are not available statewide
*Provide an enhanced service package--this allows the State to provide additional services to Medicaid beneficiaries via savings from managed care product
3. 1915(b) WAIVERS ARE LIMITED IN SCOPE: The State cannot use them to serve beneficiaries beyond Medicaid State Plan Eligibility
4. PROCESS OF APPLICATION: Once CMS receives the application for a 1915(b) waiver (submitted by the State Agency), the program will be deemed approved unless it is acted upon within 90 days. Within this time frame, CMS can approve, disapprove, or stop the 90-day clock on the process if additional information about the program is needed. The waiver programs are approved for 2 year periods, and can be renewed on an ongoing basis if the State applies. There is more information available on this site to help you find out how to apply for a 1915(b) waiver.
5. REQUIREMENTS: A 1915(b) waiver program cannot negatively impact beneficiary access, quality of care of services, and must be cost effective (cannot cost more than what the Medicaid program would have cost without the waiver).
6. EVALUATION/REPORTING REQUIREMENTS: 1915(b) waivers do not carry the evaluation requirements necessary for 1115 waivers, however, an independent assessment is due for the first two waiver periods. There is more information available on this site about the Independent Assessment Guidelines published by CMS in 1998 (PDF - 329K).
More information about 1915(b) waivers, including fact sheets, is available on our Medicaid Managed Care site.
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