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Section 1115 Medicaid and CHIP Waivers Transparency Rule

                In recent years, there have been many definite changes in health care reform. Much of this has to do with President Obama’s federalization of health care, mainly the re authorization of the Children’s Health Insurance Program and the passing of the Affordable Care Act, which makes programs like Medicaid more readily available to Americans. The most prominent of these changes is the addition of Section 1115. Waivers such as this allow for states new ways to both pay and provide for health care services in CHIP and Medicaid. With this particular waiver, Section 1115, states can be allowed to apply to test new or existing approaches to finance and deliver Medicaid and CHIP. This would further expand the services of health insurance by having more transparency in policies and more consumer input. In combination, this will improve the future of health insurance for many Americans.

What does the Affordable Care Act do?

The Affordable Care Act, commonly known as “Obamacare”, is a piece of legislation passed in 2010 in order to expand health care. It seeks to rid of boundaries that would otherwise hinder eligibility of health insurance coverage to low-income and poverty stricken Americans. It does so in the following ways:

  • Removing limitation or exclusion for people who have any pre-existing health condition, including children and teenagers under the age of 19
  • Ensuring young adults under the age of 26 have coverage under their parents’ health care plan
  • Ridding of arbitrary cancellation of health insurance coverage
  • Ensuring the right to appeal any denial of payment
  • Banning lifetime limits on insurance coverage for all new health plans
  • Reviewing premium rate increases
  • Making sure the money the client puts in is used properly, such as spending it on health care instead of administrative costs
  • Covering preventive health care at no additional cost to the client
  • Protecting the client’s choice of medical doctors
  • Removing barriers set up by insurance companies for emergency services

(http://www.hhs.gov/healthcare/rights/index.html)

What is the Children’s Health Insurance Program?

CHIP or the Children’s Health Insurance Program exists to give aid and assistance to children in health coverage, due in much part from the ACA’s support. Originally, it was vetoed by President Bush in 2007 for threatening to federalize health care and take power away from the states. In 2009, President Obama reauthorized the program. CHIP attempts to provide many benefits to children, including:

  • Oral care such as dentists visits
  • Eye exams and glasses
  • The ability to choose doctors
  • Prescription drugs and vaccines
  • Mental health care
  • Hospital care and services
  • Lab tests
  • Special health needs treatment
  • Treatment of pre-existing conditions

(http://www.chipmedicaid.org/en/Benefits)

The Benefits of Section 1115

Section 1115 under the Social Security Act grants the Secretary of Health and Human Services the authority to approve experimental, pilot, or demonstration projects that aid health insurance programs like Medicaid and CHIP. The goal of this is to give the states additional flexibility to design and improve their health insurance programs. Section 1115 attempts to achieve this by:

  • Expanding eligibility of Medicaid and CHIP to individuals who are currently not eligible
  • Providing services not that is usually not covered by Medicaid
  • Using innovative service delivery systems that improve care, increase efficiency, and reduce costs

These demonstrations are set for a five-year period and can be renewed, usually for an additional three years. Section 1115 demonstrations must not be a budget burden on the federal government, meaning the costs of this project will not be more than the federal spending without the waiver.

Another great benefit from the Affordable Care Act is the fact it greatly increases consumer input. For instance, the ACA now requires for public comments and greater transparency of demonstration projects.  Established in April 27, 2012, a rule makes it mandatory to ensure public input into the development and approval of any new demonstrations. This also applies to extensions of existing demonstrations. All demonstrations, both applied and approved, are made publicly available at federal and state levels. This ensures that the public will have an opportunity to provide their input and opinions on a demonstration while it is under review at CMS. At the same time, this will also make sure the development of the demonstrations proceed in a timely manner (http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html).

 

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