New Waivers To Fill Gaps in Continuum of Care

May 30, 2015

Credit State of Alaska

Some seniors are in danger of losing access to the state’s Medicaid Waiver Program. The program pays the cost of their housing and nursing care. The state says to qualify for the C waiver applicants must meet Nursing Home Level of Care. The state plans to introduce two new waiver options to help seniors it says don't qualify.

The state wants to apply to the Centers for Medicare and Medicaid Services, or CMS, for waiver options 1915 I and 1915 K. Like option C, K requires waiver recipients to meet Nursing Home Level of Care. Here’s Senior Disabilities Services, or SDS Director Duane Mayes.

 “There are some slight differences but there are some similarities between the two. The difference is that you can draw down an additional 6% from the federal government,” said Mayes. 

In other words the Federal Government will pay 56% of the cost for Option K 

The other option- I- also brings a 50% match and would serve a whole new population.  Mayes says the department gets to decide who they want to target with that option. 

“There are those that have developmental disabilities who may not qualify for the current waiver and they may need some services,” said Mayes. 

Specifically seniors who don’t meet the department’s definition of Nursing Home Level of Care. 

“We currently expend about $13 million a year of general fund dollars for those with developmental disabilities that don’t meet eligibility requirements for the waiver. But, with the I option we’d be able to come up with [a] defined eligibility for that group,” added Mayes.

Other groups the state wants to cover with the I option include people suffering from severe mental illnesses, the dementia population, and individuals living with traumatic brain injuries. 

But there’s the question of legislative approval. Permission to apply to the federal government for these waiver options was included in the House and Senate Bills to reform and expand Medicaid. 

Taneeka Hansen, aide to Representative Paul Seaton of Homer, says the options themselves are among the least controversial parts of Medicaid Expansion. But, the bills carrying them have stalled. Hansen says it’s unclear what permissions the state has without legislative approval. 

“Without the approval they may be able to apply for a more limited version because some of the people that will be serviced are already included under coverage groups that we have. So they have some room there to apply, but it makes it more difficult. And they may not be able to make it as broad of a waiver,” said Hansen.

Mayes says one thing is clear. Adopting these waiver options could save the state a lot of money in the long run. 

“I think these options could absorb some of the general fund dollars that we’re spending currently for those with dementia, for those with traumatic brain injury. It’s a way to stretch our dollars going forward by replacing state dollars with federal dollars,” said Mayes.

If the legislature approves the states application for the new waiver options this year and nothing else goes wrong, the department could have the waivers in place in two years.