Sellers Dorsey Senior Vice President Gary Jessee was interviewed by Healthcare Innovation to share his expertise on recent innovations in Medicaid, specifically Section 1115 waivers. Gary discusses how these waivers have pioneered change for Medicaid beneficiaries including expanding access to mental health services, telehealth, substance abuse programs, and more.

What are the most pioneering things that states are doing with the Medicaid waivers up to this point?

It depends on the waiver. Medicaid is the single largest source of insurance for low-income people in this country. It’s estimated that one in five Americans is accessing Medicaid. And as we always say, if you’ve seen one Medicaid program, you’ve seen one Medicaid program. The federal government sets terms around eligibility; but there are 1115 waivers that are more like demonstrations; 1915C waivers are designed to provide long-term supports.

We’re talking here about Medicaid expansion. As part of the Affordable Care Act, Medicaid expansion allowed for expansion to adults up to 150 percent above the federal poverty level. The ACA provided an option for states to adopt Medicaid expansion. And 41 states have opted to expand Medicaid eligibility to that level; ten states, including the one I’m in, have chosen not to do so. The goal was to expand insurance coverage, but also to help providers with their uncompensated care burdens.
Some states focus their efforts through their 1115 waivers. And some states that have expanded Medicaid have included work requirements, and those received significant pushback from our federal partners, and most of those requirements were abandoned.