A state Medicaid agency set a goal of covering childless adults with income up to 100% of the federal poverty level (FPL) under the Affordable Care Act. Prior to, these adults had been eligible for Medicaid, but their benefit package was limited. Enlisting Sellers Dorsey’s help, the state Medicaid agency chose to meet their goal by developing a Section 1115 waiver to provide a full benefit package to these adults and subsidize private insurance for those over 100% of the FPL.

The Collaboration

Many steps went into making this waiver project a success, and by collaborating with the state’s Medicaid agency, Sellers Dorsey assisted with each one of them. This process included:

  • Providing strategic counsel on policy and financing
  • Financial modeling
  • Developing federal budget neutrality
  • Evaluation approach
  • Creating a process for health needs assessments
  • Drafting a proposed application for public comment
  • On-site support for public meetings
  • Drafting responses to public comments
  • Final draft of demonstration application to CMS
  • Providing strategic advice during CMS negotiations
  • Editing waiver terms and conditions and transition advice

The Results

With our help and approach, the Section 1115 demonstration waiver won a five-year federal approval. Not only did Sellers Dorsey help achieve the desired outcomes, they helped the state meet budget expectations, as well. The two-fold Medicaid reform and fiscal goals were met, and the final product included a creative budget neutrality model, favorable terms and conditions, and more than $1 billion in new federal funding for the state.