CURRENT ADVOCACY

Medicaid 1115 Research and Demonstration Waivers

Medicaid is an incredibly important source of health care coverage for people with psychiatric disabilities that provides access to mental health services, including some intensive community-based services that are unavailable through private health insurance. States can request Medicaid waivers or amendments that can be helpful in expanding access to particular services. Unfortunately, states sometimes wish to use these waivers to create bureaucratic barriers to coverage or to invest in ineffective or unnecessary services.

 In recent months, the Trump Administration has, contrary to statutory language in our view, approved Medicaid waivers in states that institute work requirements for Medicaid beneficiaries. These requirements, which would cut off Medicaid coverage for certain beneficiaries who do not secure work or participate in related activities, are of great concern.  While it is critically important to expand work opportunities and employment services for Medicaid beneficiaries, including those with psychiatric disabilities, the work requirements that have been approved would do little to expand work opportunities and instead would result in a loss of health care coverage for people who have trouble obtaining jobs.  Some of these waivers have also included time limits on coverage and other onerous conditions on eligibility for low-income Americans.

The Administration is also considering some waivers that included requests to increase spending on institutional mental health services, at the expense of community-based mental health services, or that ignore statutory or guidance documents that require comprehensive behavioral health systems reform.

The Bazelon Center has been carefully tracking and commenting on these waivers and you can read our comment letters here.  We expect to see additional states seeking waivers to impose work requirements or otherwise limit Medicaid coverage, or to expand coverage of institutional care, and we will continue to submit comments on those applications to the federal government.

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