Cardinal Innovations provides access to Medicaid behavioral health and developmental disabilities services through 1915(b) and 1915(c) waivers, which are allowed under the Social Security Act to give states more flexibility in operating Medicaid programs.
The 1915(b) waivers are used to implement mandatory enrollment of Medicaid recipients in managed care through prepaid health plans, health maintenance organizations (HMO) and primary care case management programs.
States that implement 1915(b) waivers must comply with the federal regulations that govern managed care delivery systems regarding quality assurance and performance improvement; reasonable access to providers; grievance and appeal rights; and cost effectiveness.
The 1915(c) waivers allow long-term services and supports in an individual's home and community instead of an institution. Nursing facilities, intermediate care facilities for individuals with intellectual disabilities (ICF/IID) and hospitals are considered institutions under this waiver authority.
In 2005, Cardinal Innovations and the state Medicaid agency worked together to develop and implement concurrent 1915(b)/(c) waivers for behavioral health and intellectual/developmental disabilities services. This allowed for a managed care delivery system, covering both Medicaid state plan services and long-term services and supports created under the 1915(c) waiver. The waivers were implemented as a demonstration in Cardinal Innovations' original catchment area – Cabarrus, Davidson, Rowan, Stanly and Union counties. Significant savings and increased quality of care were achieved during the demonstration. As a result, the waiver program was expanded statewide in 2013.
For a full description of the waivers, click here >
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