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1915(b) Managed Care Waivers

1915(b) Waivers are one of several options available to states that allow the use of Managed Care in the Medicaid Program. When using 1915(b), states have four different options:

  • [1915(b)(1)] - Implement a managed care delivery system that restricts the types of providers that people can use to get Medicaid benefits
  • [1915(b)(2)] - Allow a county or local government to act as a choice counselor or enrollment broker) in order to help people pick a managed care plan
  • [1915(b)(3)] - Use the savings that the state gets from a managed care delivery system  to provide additional services
  • [1915(b)(4)] - Restrict the number or type of providers who can provide specific Medicaid services (such as disease management or transportation)

CMS has begun the process of "modularizing" its current 1915(b) waiver application to separate the various statutory authorities.  First in this process is a streamlined application for States to selectively contract with providers under their fee-for-service delivery system.  It simplifies the process for documenting the cost-effectiveness of the waiver but requires that States demonstrate maintenance of beneficiary access.  Below are links to both the fillable PDF application as well as the technical guide for completing the application. 

More information on approved 1915(b) waivers is available.