CMS Issues Guidance on State Medicaid Demonstration Programs for Dual Eligibles - November 16, 2010

The federal Centers for Medicare & Medicaid Services (CMS) on Nov. 9 issued a State Medicaid Director letter regarding the five-year approval or renewal period for Medicaid waivers targeted at individuals who are dually eligible for Medicare and Medicaid. Under the Affordable Care Act, waivers that target dual eligibles may automatically be approved and renewed for five-year periods, as opposed to the shorter periods typically allowed for state waivers. The CMS guidance states that for such waivers to be eligible for a five-year period, they must provide delivery system options or services not otherwise provided to dually eligible individuals under the State plan. The guidance also notes that any approvals of waivers remain at the discretion of the Secretary of the U.S. Department of Health and Human Services, and that the extended approval may be denied if the waivers fail to meet the conditions of cost neutrality (for 1915(c) waivers), cost-effectiveness (for 1915(b) waivers) or budget neutrality (for 1115 demonstrations). CMS has developed a modified application to support consideration of the dual eligibility waivers.