In an April 10 letter to State Medicaid Directors, the Centers for Medicare and Medicaid Services (CMS) announced they will approve neither new nor renewals of specific section 1115 waivers that use designated state health plans (DSHP) and designated state investment program (DSIP) funds.
These programs, implemented in 2005, allowed states to transition state funded programs that were health care-adjacent, like those addressing health related social needs or for special populations, into Medicaid demonstrations under section 1115.
Starting in 2005, states could receive a federal match for these health-care adjacent programs and use the prior state money, now partially replaced with federal matching dollars, both on the DSHP and DSIP programs themselves and/or reinvest those funds in other Medicaid programs.
Some examples of these programs include housing and nutrition supports or infrastructure improvements to facilitate access for individuals transitioning from incarceration.
The April 10 state plan letter explains the Trump administration’s position against continuing a federal match for programs that states previously funded themselves and raises questions about oversight of these initiatives and where the federal funds are going.
In some states, services delivered by LeadingAge members could be included in these waivers. In those instances, states will make difficult decisions at the time of waiver renewal about how or if those services will continue to be covered. LeadingAge will continue to monitor and would appreciate feedback from state partners and members with information on their state’s DSIP and DSHP programs.