Medicaid 1115 Block Grant Waivers

CMS Healthy Adult Opportunity proposal, January 30, 2020

smd20001

Healthy Adult Opportunity application template, January 30, 2020

hao-application-template

Healthy Adult Opportunity press release, January 30, 2020

https://www.cms.gov/newsroom/press-releases/trum-administration-announces-transformative-medicaid-healthy-adult-opportunity

Healthy Adult Opportunity Fact Sheet, January 30, 2020

https://www.cms.gov/newsroom/fact-sheets/healthy-adult-opportunity

Medicaid facts and figures, January 30, 2020

https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-figures

Letter to Secretary Azar from Chairman Pallone, June 26, 2019

HHS.2019.6.26.

CMS Administrator Seema Verma’s speech to state Medicaid directors, November 12, 2019

https://www.cms.gov/newsroom/press-releases/cms-administrator-seema-vermas-speech-national-association-medicaid-directors-washington-dc

Politico.com article, January 23, 2020

https://www.politico.com/news/2020/01/23/trump-targeting-obamacare-102887

Politico.com article, January 29, 2020

https://www.politico.com/news/2020/01/29/trump-medicaid-overhaul-block-grants-108882

Manatt post, January 31, 2020

https://www.commonwealthfund.org/blog/2020/what-does-new-block-grant-guidance-mean-medicaid-program

Manatt paper, February 2020

Manatt-Health_CMS-Guidance-Authorizes-Medicaid-Demonstration-Applications-That-Cap-Federal-Funding_Implications-for-States

CBPP FAQ paper, February 6, 2020

2-6-20health_0

Lawrence, Midnight Waivers: Can They Be Revoked Through the Congressional Review Act?, January 6, 2021

Lawrence waivers CRA

Lawrence, FISCAL WAIVERS AND STATE “INNOVATION” IN HEALTH CARE
Forthcoming, William & Mary L. Rev. (2021)

SSRN-id3720856

ACA 1115 waiver provisions, 2010, and CMS implementing regulations, 2012

Sec. 10201(i)

1115 d – f

42 C.F.R. secs. 431.400-.428

42 cfr 431.400-.428

CMS, Medicaid Program; Review and Approval Process for Section 1115 Demonstrations, 77 Fed. Reg. 11,678 (Feb. 27, 2012)

2012-4354

CMS Dear State Medicaid Director letter re 1115 regulations

SHO-12-001

CMS Information Bulletin, November 6, 2017

cib110617

ARKANSAS

Commonwealth Fund paper on Arkansas private option, 2017

https://www.commonwealthfund.org/publications/issue-briefs/2017/feb/evidence-private-option-arkansas-experience

CMS approval of Arkansas private option waiver, September 27, 2013

ar-private-option-app-ltr-09272013

NEW YORK

Waiver amendment approval, March 31, 2014

ny-partnership-plan-amendment-approval-03312014

Waiver amendment approval, April 14, 2014

ny-partnership-plan-cms-dsrip-amend-appvl-04142014

Waiver amendment approval, December 7, 2016

ny-medicaid-rdsgn-team-appvl-120716

RHODE ISLAND

Global Waiver application, March 2008

RIGlobalConsumerChoiceCompactWaiverFinal3-26-08toCMSmodified

Global Waiver legislation, 2008

2008 Rhode Island General Laws

Global Waiver Approval, January 16, 2009

GlobalWaiverFinal1-09

American Action Forum paper, 2011

OHC_NGA Winter Meeting_Medicaid_Final Draft

CBPP paper, 2011

3-16-11health2

RWJ paper, 2013

RI_Global_Waiver_Brief_FINAL

MASSACHUSETTS (prescription drug issues)

Waiver amendment request, September 8, 2017

masshealth-section-1115-demonstration-amendment-request-09-08-17masshealth-section-1115-demonstration-amendment-request-09-08-17

CMS partial approval, June 27, 2018

ma-masshealth-demo-amndmnt-appvl-jun-2018

Massachusetts response to partial approval, July 27, 2018

ma-masshealth-amndmnt-acknowledgement-ltr-072718

TENNESSEE

HB 1280, as it passed the Tennessee House [?]

HB1280

Tennessee Senate GOP press release, April 16, 2019

https://www.tngopsenate.com/2019/04/16/new-amendment-ensures-full-funding-and-maximum-flexibility-in-proposed-tenncare-block-waiver-program/

Center for Nonprofit Management column, April 17, 2019

https://www.cnm.org/CNMMembership/Links/Blog/April-2019/Medicaid-Block-Grant-for-Tennessee

Knoxville Ledger story, April 18, 2019

http://www.tnledger.com/knoxville/editorial/ArticleEmail.aspx?id=116857&print=1

The Tennessee bill as enacted, I think …

CC0016

American Cancer Society, etc., letter, July 25, 2019

tennessee-health-partner

Tennesseean story, September 2, 2019

https://www.tennessean.com/story/news/politics/2019/09/03/bill-lee-block-grant-tennessee-medicaid-tenncare/2165394001/

Tennessee public hearing notice, September 17, 2019

Amendment42ComprehensiveNotice

Tennessee block grant waiver Amendment 42 (draft), September 17, 2019

TennCareAmendment42

Washington Post story, September 17, 2019

https://beta.washingtonpost.com/health/tennessee-becomes-first-state-with-a-plan-to-turn-medicaid-into-a-block-grant/2019/09/17/9a4ba518-d88e-11e9-ac63-3016711543fe_story.html

Andy Schneider analysis, September 25, 2019

Tennessee Medicaid “Block Grant” Proposal: Imagination Gone Wild

Tennessee updated public hearing notice, October 4, 2019

Amendment42ComprehensiveNotice updated 10 4 19

Tennessee frequently asked questions

TennCareAmendment42FAQs

Tennessee commentary on misunderstandings

Amendment42MisunderstandingsClarifyingFacts

Tennessee public comments

PublicCommentsOnAmendment42

TennCare Amendment 42, November 20, 2019

tn-tenncare-ii-pa10

Redline version

Amendment42RedlineVersion

NHeLP letter, November 26, 2019

TennCare-Letter-for-publication

Completeness letter, November 26, 2019

tn-tenncare-ii-amend-42-complete-ltr-20191126

Congressional letter re block grants, January 14, 2020

TN

TennCare III approval, January 8, 2021

tenncarewaiver

Kaiser Family Foundation story, January 8, 2021

Trump Administration Approves First Medicaid Block Grant, in Tennessee

McCutchen v. Becerra, No. 1:21-cv-1112 (D. D.C., filed April 23, 2021)

Complaint

merged_64485_-1-1619787409

Tennessee motion to intervene, May 20, 2021

merged_87067_-1-1621983816

Amended complaint, May 26, 2021

7153667-0–48736

US nonopposition to Tennessee motion to intervene, June 2, 2021

7164086-0–76129

Tennessee proposed answer in intervention, June 8, 2021

merged_91331_-1-1623424463

US unopposed motion for extension of time to answer, June 22, 2021

merged_20947_-1-1624412644

06/28/2021 MINUTE ORDER: Granting 28 Motion for Extension of Deadlines. The federal defendants shall answer or otherwise respond to the Complaint by 8/27/21. Signed by Judge Tanya S. Chutkan on 6/28/21. (DJS) (Entered: 06/28/2021)

Unopposed motion for abeyance, August 11, 2021

merged_15334_-1-1628864018

08/11/2021 MINUTE ORDER: Granting Unopposed 29 Motion to Stay. This action is hereby STAYED pending the outcome of the new comment period pertaining to the challenged agency decision of January 8, 2021. The parties shall file a Joint Status Report and propose order within 30 days of whatever decision is issued following the new comment period. Signed by Judge Tanya S. Chutkan on 8/11/21. (DJS) (Entered: 08/11/2021)

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TEXAS

Application, November 2020, preceded by CMS completeness letter, Dec. 15, 2020

tx-healthcare-transformation-cmplt-ltr-state-phe-app-20201215

Approval, Jan. 15, 2021

tx-healthcare-transformation-cms-approval-01152021

Letter from CMS to Texas, April 16, 2021

tx-healthcare-transformation-ca_1

Texas v. Richter, No. 6:21-cv-191 (E.D. Tex., filed May 14, 2021)

Complaint, including exhibits

merged_27427_-1-1621018081

Motion for preliminary injunction, July 16, 2021

merged_80134_-1-1626834861

merged_15517_-1-1626834964

merged_11423_-1-1626835107

merged_2989_-1-1626835202

merged_70240_-1-1626835296

Scheduling order, July 16, 2021

13064216-0–4669

Motion by legislators to allow amicus filing, July 23, 2021

merged_17089_-1-1627163398

Legislators’ amicus, July 23, 2021

13074177-0–66200

US response to motion for preliminary injunction, July 26, 2021

merged_99706_-1-1627392635

13077709-0–103819

07/27/2021 MINUTE ORDER that the Clerk of Court shall update the docket to substitute Elizabeth Richter for Chiquita Brooks-LaSure pursuant to Federal Rule of Civil Procedure 25(d). Ordered by District Judge J. Campbell Barker on 7/27/2021. (ndc) (Entered: 07/27/2021)

Scheduling order, July 27, 2021

TX v CMS scheduling order 7 27

Every Texan amicus, July 27, 2021

merged_52174_-1-1627485208

Scheduling order, July 29, 2021

13081657-0–69559

Texas reply supporting preliminary injunction, August 3, 2021

TX v. LaSure pltf PI reply

Parties’ joint motion for extensions, August 3, 2021

TX v LaSure joint xt request

Extension and scheduling order, August 4, 2021

TX v US xt order

Hearing protocols order, August 10, 2021

13099680-0–109087

Texas motion for TRO, August 11, 2021

TX TRO mo 8 11 21

Errata to Texas motion for TRO, August 11, 2021

TX TRO errata 8 11 21

Texas supplemental brief on reviewability, August 11, 2021

13101763-0–44866

08/12/2021 MINUTE ORDER that defendants respond to 34 plaintiffs’ motion for temporary restraining order by 3:00 p.m. CST today, August 12, 2021. A telephone hearing on that motion is set for today at 4:00 p.m. CST. Dial-in instructions will be issued in due course. Ordered by District Judge J. Campbell Barker on 8/12/2021. (ndc) (Entered: 08/12/2021)
08/12/2021 NOTICE of Hearing on 34 opposed motion for temporary restraining order. Motion Hearing set for 8/12/2021 at 04:00 PM by telephone before District Judge J. Campbell Barker. The court’s public telephone number is (877) 336-1839. Access code: 3637904. Participants will receive dial-in instructions for the hearing line separately by email. Participants should use a landline phone connection. (ndc) (Entered: 08/12/2021

US sur-reply, August 12, 2021

US sur reply 8 12 21

US TRO opposition, August 12, 2021

US TRO op 8 12

Minute entry, August 12, 2021

13103755-0–18666

Order to clarify sanctions standards, August 12, 2021

13103779-0–105283

CMS notice and letter to Texas, August 13, 2021

CMS notice 8 13

US supplemental brief on reviewability, August 13, 2021

13107318-0–77490

Stipulation re evidence, August 16, 2021

20210816133604

Preliminary injunction, August 20, 2021

Texas v. Brooks-LaSure PI 8 20 21

Unopposed motion for leave to file amended complaint, and amended complaint, August 31, 2021

TX unop mo amended c

TX amended c

Parties’ 26(f) report, with scheduling proposals, September 8, 2021

TX v LaSure 26 f report

Scheduling order with questions, September 13, 2021

13158187-0–81457

Answer to amended complaint, September 13, 2021

13158253-0–86110

xxxxx

CMS-Texas correspondence, September 2020 through August 2021 (reverse chronological order)

Texas Healthcare Transformation and Quality Improvement Program

State: Texas
Waiver Authority:
1115
Status: Pending

Waiver Dates

Approval: 12/12/2011
Effective: 12/12/2011
Expiration: 09/30/2022

Supporting Documents

Pending Application(s) and Related Documents

Approved Application(s) and Related Documents

Date Title
06/08/2021 Demonstration Approval (PDF, 6.32 MB)
01/01/2018 Fact Sheet (PDF, 65.48 KB)

Administrative Record

Date Title
08/16/2021 Letter from State (PDF, 129.15 KB)
08/13/2021 CMS Letter to State (PDF, 228.98 KB)
07/28/2021 CMS Complete Letter (PDF, 301.41 KB)
07/06/2021 State Acceptance Letter – Amendment 17 (PDF, 144.31 KB)
04/19/2021 CMS Attachment K Approval (PDF, 448.07 KB)
04/16/2021 CMS Letter to State (PDF, 5.77 MB)
03/24/2021 CMS Complete Letter (PDF, 195.57 KB)
03/24/2021 CMS Complete Letter (PDF, 195.53 KB)
02/12/2021 CMS Letter to State (PDF, 39.08 KB)
01/20/2021 NEMT Amendment 17 (PDF, 401.28 KB) View Comments
01/15/2021 CMS Approval (PDF, 4.74 MB)
01/15/2021 State Acceptance Letter (PDF, 195.22 KB)
12/15/2020 CMS Complete Letter and State PHE Application (PDF, 3.54 MB)
10/13/2020 CMS Technical Corrections (PDF, 630.99 KB)
09/16/2020 Medically Fragile Amendment Incomplete Letter (PDF, 195.44 KB)
09/08/2020 CMS Approval – Texas Amendment 16 (PDF, 679.27 KB)
09/08/2020 CMS Approval – Texas COVID-19 Amendment (PDF, 646.4 KB)
09/02/2020 CMS Approved DSRIP Transition Plan (PDF, 665.04 KB)

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UTAH

Proposed amendment, Aug. 15, 2017

Amendment, June 22, 2018
SB 96
Approval, March 29, 2019

Utah ‘acceptance,’ April 26, 2019

ut-primary-care-network-state-acceptance-ltr-20190426-1

State web site’s explanation

Medicaid Expansion

State expansion implementation toolkit

UTAH MEDICAID EXPANSION_ Toolkit

Utah proposal, May 31, 2019

Utah 1115 Demonstration Application- Per Capita Cap- 31May2019

Utah waiver amendment proposal, November 1, 2019

Utah 1115 Waiver Amendment-Fallback Plan

CMS completeness letter, November 7, 2019

ut-primary-care-network-cms-cmplt-ltr-fallback-20191107

ALASKA?

KTOO story, 4/3/19

Alaska aims to be first state receiving federal Medicaid funding as a block grant

Letter from Gov. Dunleavy to Pres. Trump, 3/1/19

2019-March-GOA-Correspondence

The Hill story, 4/4/19

https://thehill.com/policy/healthcare/437369-trump-administration-urging-alaska-to-apply-for-medicaid-block-grant

Washington Examiner story, 4/4/19

https://www.washingtonexaminer.com/policy/healthcare/republican-governor-seeks-for-alaska-to-be-first-state-to-get-medicaid-as-a-block-grant

Georgetown discussion of 1115 waiver policy more generally, putting Alaska in context, 4/5/19

Where Does the Trump Administration’s Medicaid Waiver Policy Go Next?

Midnight Sun AK roundup, 4/5/19

http://midnightsunak.com/2019/04/05/friday-in-the-sun-april-5-the-fiscal-responsibility-matters-edition/

Alaska Landmine Sunday Minefield, 4/7/19

The Sunday Minefield – April 7, 2019

Anchorage Daily News story, 4/14/19

https://www.adn.com/politics/2019/04/14/alaska-advocacy-groups-push-back-on-dunleavys-interest-in-block-grant-funding-for-medicaid/

ANCOR story, 4/15/19

https://ancor.org/newsroom/news/worrisome-tremors-trump-administration-works-state-route-medicaid-block-grants

Daily Kos story, 4/18/19

https://www.dailykos.com/stories/1851269

Dermot Cole commentary, 4/19/19

https://www.dermotcole.com/reportingfromalaska/2019/4/18/health-commissioner-says-that-contrary-to-trump-letter-state-isnt-seeking-medicaid-block-grant

Barbara Norton column, 4/23/19

https://www.adn.com/opinions/2019/04/24/making-medicaid-a-block-grant-will-endanger-alaskans/

Dermot Cole column, 5/16/19

https://www.dermotcole.com/reportingfromalaska/2019/5/15/in-another-reversal-state-now-says-it-will-study-block-grant-for-medicaid

ADN story, 5/20/19

https://www.adn.com/business-economy/2019/05/20/alaska-health-department-seeks-review-of-its-medicaid-overhaul-plan/

Proof of Concept Analysis request for proposals

IRFP_190000114_ProofOfConceptAnalysis

Amendment, 5/17

IRFP_190000114_Amendment_1

Alaska Journal of Commerce story, 6/5/19

http://www.alaskajournal.com/2019-06-05/state-awards-contract-medicaid-block-grant-study

Alaska Mental Health Trust Authority webinar, I, 7/18/19

AK-Trust-Block-Grant-Session-1-Slides-final

Audio from session I

Alaska Mental Health Trust Authority, webinar 2, July 23, 2019

Key considerations for negotiating the budget for a Medicaid block grant

Watch the full presentation video and audio

Download the presentation slides

July 23, 2019, 9:30-11:00 am

Public Consulting Group, “Proof of Concept” paper, August 5, 2019

pcg_medicaid_reportl

Alaska Journal of Commerce story, August 14, 2019

http://www.alaskajournal.com/2019-08-14/report-concludes-private-medicaid-doable-costs-uncertain

Alaska Mental Health Trust Authority, webinar 3, August 20, 2019

Key considerations for negotiating the terms and conditions of the block grant

Watch the full presentation video and audio

Download the presentation slides

August 20, 2019, 9:30-11:00 am

Dear State Medicaid Director letter on budget neutrality, August 22, 2018

smd18009

ALASKA LEGISLATIVE PROPOSALS

HB 135 / SB 112, introduced 4/15/19

Transmittal letter, 4/12/19

HB 135 Governor’s Transmittal Letter 4 15 19

HB 135

HB0135A

SB 112

SB0112A

Fiscal note 1 (Corrections)

HB0135-1-2-041519-COR-N

Fiscal note 2 (Div. of Insurance)

HB0135-2-2-041519-CED-Y

Fiscal note 3 (DHSS — Behavioral Health)

HB0135-3-2-041519-DHS-Y

Fiscal note 4 (DHSS)

HB0135-4-2-041519-DHS-Y

Fiscal note 5 (DHSS)

HB0135-5-2-041519-DHS-Y

Fiscal note 6 (DHSS)

HB0135-6-3-041519-DHS-Y

Fiscal note 7 (DHSS)

HB0135-7-2-041519-DHS-Y

Fiscal note 8 (DHSS)

HB0135-8-2-041519-DHS-Y

Section by section [date?]

SB 112 detailed sectional analysis – with incorrect HB 135 analysis

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