Waiver and State Plan Design
Managing Medicaid plans poses especially complicated and burdensome challenges. Medicaid is funded by state and federal governments and administered by 50 state agencies. Each state utilizes a waiver process to design its Medicaid plans to meet to deliver appropriate care to the needs of its citizens and create cost effective models. Complying with extensive federal restrictions and disparate state programs make Medicaid plans daunting to design and administer.
AG help states to obtain waivers and to design, develop, and implement innovative programs that will contain costs, improve quality of care, ensure appropriate services are delivered, improve consumer satisfaction, and maintain compliance with Centers for Medicare and Medicaid Services (CMS) requirements. State Medicaid agencies are faced with laws, regulations, and policy guidelines governing the individuals and families they may enroll in the program, the services they may cover, and the reimbursement methods they may use. States must obtain waivers from CMS if they wish to innovate, restrict recipient choice among qualified provider organizations, offer targeted services to groups with unique needs, or to offer different benefits in different geographic areas within the state. States are also faced with a federal government that may not be attentive to urgent needs and changing financial circumstances. These states need immediate resolution for their Medicaid applications. AG can answer all of these needs and more.
AG Solutions helps states with waiver creation, design and implementation and other Medicaid issues such as:
- Global Waivers that waive onerous federal rules and mandates to create a dynamic and cost-effective continuum of care focused on appropriate level of services, transparency, right services in the right setting, reducing institutional care in favor of home and community based services, intense care management, eradicating fraud, waste and abuse and information technology solutions.
- Waiver Streamlining and Consolidation
- Section 1115 waivers that include Long Term Care and/or Acute Care
- Home and community-based services tailored to the needs of the frail elderly and physically disabled persons at risk of nursing home placement, individuals with intellectual disabilities requiring the level of care provided in ICFs/MR, and other individuals at risk of institutional care, such as medically fragile children and individuals with AIDS;
- Waivers of recipient free choice to permit mandatory enrollment in high quality, low and cost-effective delivery systems, such as HMOs, capitated behavioral health plans or directing recipients to a health care transparency portal to deliver high quality low cost services;
- Programs that utilize community-based primary care practitioners to offer regular preventive care and wellness and to manage the delivery of inpatient and specialty care when needed;
- Demonstration projects offering unique eligibility, coverage, and reimbursement incentives and strategies on a statewide basis, or in regional pilot programs.
- Medicaid Budget Savings Initiatives
- Assist states that are struggling with CMS Waiver approvals.