Federal waivers allow states to test new ways to deliver and pay for health care services. Changes to the state’s Medicaid program often require waivers approved by the federal Centers for Medicare & Medicaid Services (CMS) to continue receiving federal Medicaid funding. The following are waivers that the Minnesota Department of Human Services (DHS) has applied for or received.
This demonstration project is an important component of the state’s larger reform effort to address the opioid crisis as well as transform the health care delivery system for Medicaid enrollees who need substance use disorder treatment. State law directs DHS to implement the recently approved federal waiver to receive Medicaid matching funds for residential programs that have been determined as Institutions for Mental Disease (IMDs). After it is implemented, the five-year demonstration project will test the impact of evidence-based provider referral arrangements and practices on improving health outcomes for Medicaid enrollees with substance use conditions.
SUD Waiver Reports to CMS
The SUD waiver special terms and conditions require the state to provide updates to CMS on the demonstration’s implementation. We submit reports quarterly and annually.
SUD Demonstration Year 1 (July 1, 2019-June 30, 2020)
Cover children under Medical Assistance who are 12 to 23 months old with income eligibility above 275% and at or below 283% of the federal poverty level (FPL)
Waive the federal requirement to redetermine the basis of Medical Assistance eligibility for caretaker adults with incomes at or below 133% of the FPL who live with children age 18 who are not full-time secondary school students;
Provide Medical Assistance benefits to pregnant women during the period of presumptive eligibility; and
Fund graduate medical education through the Medical Education Research Costs (MERC) trust fund.
A request to extend the PMAP+ waiver for an additional five-year period was submitted to CMS on June 29, 2020. CMS approved a temporary extension of the current waiver through Dec. 31, 2021, to allow the state and CMS to continue working together on approval of the extension of the waiver. On December 9, 2021, CMS approved a second temporary extension of the PMAP+ waiver through December 31, 2022. See the PMAP+ Waiver Extension Request (PDF) for information about the extension request.
PMAP+ waiver reports to CMS
The PMAP+ waiver special terms and conditions require the state to provide updates to CMS on the program’s implementation. We submit reports quarterly and annually. Reports from prior demonstration years have been archived and can be made available by request via firstname.lastname@example.org.
PMAP+ Demonstration Year 21 (July 1, 2015 - June 30, 2016)
The demonstration provides federal support for the Alternative Care program, which provides supports to help seniors at risk of nursing home placement to stay in their homes.
On April 21, 2022 DHS submitted a request to amend the Reform 2020 1115 waiver to reflect the addition of Community First Services and Supports (CFSS) as a benefit under the Alternative Care Program.
DHS is redesigning its state plan personal care assistance (PCA) services to expand self-directed options under CFSS. The CFSS benefit will expand person’s choices about how they receive their services, including who can provide services, additional support for writing plans, more self-direction options and the ability to purchase goods that aid a person’s independence. DHS has applied to CMS under section 1915(i) and 1915(k) of the Social Security Act to add CFSS as a new Medical Assistance benefit. A 30-day comment period for the 1915(i) and 1915(k) state plan amendments was held from Jan. 4, 2022, to Feb. 4, 2022. More information about the state plan amendments and the transition to CFSS can be found on the Public comment period for Community First Services and Supports AASD and DSD eList announcement.
CFSS will eventually replace PCA services for seniors participating in the Alternative Care program. This will happen gradually, after every eligible person has received an assessment under the new benefit. CFSS covers all the services currently covered by PCA and eligibility requirements for CFSS will be the same as PCA.
The Reform 2020 waiver special terms and conditions require the state to provide updates on the program’s implementation to CMS. Reports are submitted on a quarterly and annual basis. Reports from prior demonstration years have been archived and can be made available by request via email@example.com.
Reform 2020 Demonstration Year III (July 1, 2015 - June 30, 2016)
The 2016 Minnesota State Legislature directed DHS to seek federal waiver authority to allow tribal organizations to receive the Indian Health Services encounter rate for Medicaid services provided to American Indian and Alaskan Native populations. Only organizations that are dually certified as Urban Indian Health Programs and Federally Qualified Health organizations qualify. The Legislature also asked DHS to seek authority for the state to be eligible for 100% federal financial participation for such services. (See Minnesota Statutes 256B.0625, subdivisions 30 and 34.)
On Jan. 13, 2017, DHS submitted the Indian Health Board (IHB) of Minneapolis Section 1115 waiver request to the Centers for Medicare & Medicaid Services (CMS). Currently, the IHB is the only entity eligible under this waiver authority, should it be granted by CMS. As a demonstration project under section 1115 of the Social Security Act, DHS plans to test new ways to help urban American Indians served by the IHB to access quality health care. This approach includes the use of an abbreviated application process for American Indians eligible for Medicaid and targeting additional funding for the IHB into enhanced care coordination and application assistance for this population.
The IHB waiver application was initially submitted to CMS on Jan. 13, 2017. A 30-day comment period on the initial IHB waiver application was held before submission, beginning on Dec. 12, 2016. The initial application was revised to include information on the research hypothesis and evaluation parameters related to the demonstration’s proposed goals. A 30-day comment period on the revised waiver application began on Apr. 17, 2017. The revised application was submitted to CMS on May 17, 2017.
CMS will hold a federal comment period following DHS’ submission of the IHB waiver request. At that time you may submit comments directly to CMS by going to the Medicaid Section 1115 Demonstrations (enter Minnesota in the search box) webpage.
The MSC+ waiver allows Minnesota to require seniors to enroll in managed care to receive Medicaid services. This includes people who are dually eligible for both Medicaid and Medicare and who have not opted to enroll in Minnesota Senior Health Options (MSHO). The waiver operates in combination with Minnesota’s existing Elderly Waiver to enable the integration of community-based long-term care services into the managed care service delivery system. The waiver also provides federal authority to require certain populations eligible for Medical Assistance to enroll in managed care, including American Indians and children who are in foster care.
On March 28, 2022, DHS submitted a request to amend the MSC+ waiver to reflect the addition of Community First Services and Supports (CFSS) to Minnesota’s Medicaid plan. This change to the MSC+ 1915(b) waiver will allow managed care organizations (MCOs) to administer the CFSS benefit for people age 65 and older who are enrolled in MSC+. Review the MSC+ Waiver Amendment Request (PDF) for more information.
The CCDTF waiver allows recipients to be directed to a provider designated by the locality. While the state has developed a transition plan to move toward a direct-access model for people seeking SUD services, it is expected that implementation will require a phased-in approach. Therefore, the CCDTF waiver has been extended while the transition to a direct-access model is completed. See the CCDTF waiver and CMS approval letter (PDF) for more information about this approval.
The two-year extension of the CCDTF waiver expires June 30, 2022.
The Case Management waiver allows Minnesota to continue to limit case management providers for the home and community-based waivers to counties and tribes under contract with DHS or their subcontractors. The waiver applies only to enrollees whose waiver services are covered fee-for-service and who receive services under one of the following Section 1915(c) home and community-based waiver programs:
Developmental Disabilities Waiver (DD)
Elderly Waiver (EW)
Community Access for Disability Inclusion (CADI) Waiver
This is a free email subscription service that allows you to receive one-way email notification when new information is available about Medicaid waivers, such as the Reform 2020 waiver, the Prepaid Medical Assistance Plus (PMAP+) waiver, the Minnesota Senior Care Plus waiver and new waiver applications. Subscribers will receive emails when DHS is seeking public comment on items that will be submitted for federal approval, when requests for federal authority are submitted to the federal government, and when waiver requests have been approved or denied.