Cardinal Innovations Healthcare and soon other LME’s in NC will manage Medicaid costs for their citizens. Medicaid costs are one of the most significant line items in the state’s budget. One way to manage Medicaid costs is with a Freedom of Choice Waiver. This is called a 1915(b) Waiver because the rules are under 1915(b) in federal regulations.
The “c” Waiver is a Home and Community Based Services Waiver.
What is a 1915(b)(c) waiver?
A Waiver is an agreement between the state and Center for Medicaid Services in Washington to be exempted from certain Medicaid rules. A waiver is necessary for the state to enter into managed care contracts because of the transfer of risk (of losing money) from the state to a Managed Care Organization. It requires the MCO to have an adequate risk reserve. It requires the Managed Care Organization to provide organizational functions found in a typical health insurance plan such Management of the Provider Network, Quality Management, and Utilization Management.
What benefits should a Waiver provide to Members?
What must Waiver LMEs/MCOs offer to members?
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