The Centers for Medicare & Medicaid Services today released new Medicaid guidance to states that would enable them to apply for 1115 waiver authority to receive a defined amount of federal funding to cover services for certain healthy adults. This approach is commonly referred to as a “block grant” or a “per capita cap,” depending on the structure. As part of the “Healthy Adult Opportunity” waivers, states will be permitted, among other things, to request changes in eligibility, covered benefits and cost-sharing. States are not required to apply for these waivers or to apply for all of the available flexibilities; the decision to apply, and the specific requests within the waiver, are wholly within states’ discretion.

The guidance is effective immediately, as is standard practice for CMS guidance to states on what the agency considers allowable uses of 1115 authority.

Related News Articles

Headline
The Congressional Budget Office today released its estimate of the budgetary effects of the One Big Beautiful Bill Act, as enacted. CBO projects the law will…
Headline
The Centers for Medicare & Medicaid Services July 17 issued two letters to states regarding policies on continuous eligibility and workforce initiatives.…
Headline
Sen. Josh Hawley, R-Mo., July 15 introduced legislation that would repeal some of the Medicaid funding reductions included in the recently enacted One Big…
Headline
The House July 3 voted 218-214 to pass the final version of the One Big Beautiful Bill Act (H.R. 1), which enacts many of President Trump’s legislative…
Headline
The Senate narrowly passed the One Big Beautiful Bill Act (H.R. 1) on July 1 by a 50-50 tally, with Vice President J.D. Vance casting the tie-breaking vote.…
Headline
The AHA June 29 sent a letter to senators urging them to amend the budget reconciliation bill before its final passage in the Senate. The Senate version of the…