1115 Waiver Guidance is Out!

We have just heard from the Centers for Medicare and Medicaid Services (CMS) that our advocacy efforts have been successful. As part of its pledge under the National HIV/AIDS Strategy, CMS has just released guidance and an application template to make it easier for states to apply for Section 1115 Medicaid waivers to cover pre-disabled people living with HIV. This is a huge victory for the HIV/AIDS community.

An 1115 waiver gives a state flexibility to expand its Medicaid program. The waiver is particularly important for the HIV/AIDS community because of the cruel “catch 22” of current Medicaid law, which requires people living with HIV to wait until they are disabled by AIDS to qualify for Medicaid. Health care reform eliminates this “catch 22” when, starting in 2014, most people with income at or below 133% of the federal poverty level will be eligible for the program. An 1115 waiver will allow a state to provide a bridge to 2014 and immediately cover pre-disabled people living with HIV under its Medicaid program.

While we were hoping that CMS would provide more details about how states can reach budget neutrality, we have been assured that CMS is committed to working with states on an individual basis to explore the broad range of strategies available for meeting budget neutrality requirements. Within the next few weeks, we will develop an outline of potential models that states can use to show budget neutrality. They can and will work!

Now it’s up to advocates to ensure that state Medicaid offices, AIDS directors, and state legislators are aware of the 1115 waiver option and take the necessary steps to apply for the waiver. We know that this will not be an easy lift given the current state of the economy. But, we also know that immediate access to care and treatment will save lives and is very cost-effective.

We are attaching a press release about the guidance and encourage you to use it (and adapt it to your needs) as you spread the word in your state about the 1115 waiver. A copy of the guidance is available at: https://www.cms.gov/smdl/downloads/11-005.pdf.

Stay tuned over the next couple of weeks as we develop and disseminate advocacy material and resources to help make the 1115 waiver option a reality. Material can be found on the Dose of Change website (www.doseofchange.org) or the Treatment Access Expansion Project website (www.taepusa.org).

What can I do?

  • Webinar on the guidance and next steps for advocacy: TBD
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