Idaho Behavioral Health Transformation Waiver

The Centers for Medicare and Medicaid Services approved the state’s Behavioral Health Transformation Section 1115 demonstration waiver in April 2020

About the waiver

This demonstration will run for five years and provide the state with authority to provide high-quality, clinically appropriate treatment to participants with mental health and substance use disorders. The waiver will also support state efforts to implement models of care focused on increasing support for individuals in the community and home, outside of institutions, and improve access to care and expand services to cover a continuum of behavioral health evidence-based practices.

Goals of this waiver include increased access to and availability of care, expanded coverage of Medicaid services, improved care coordination, and transitions between levels of care. Achievement of these goals will reduce emergency department visits and inpatient psychiatric hospitalizations.

To see documents related to this waiver please visit the Idaho Behavioral Health Waiver Library

Additional Information
Idaho Managed Care Risk Mitigation COVID-19 Public Health Emergency (PHE Medicaid Section 1115 Demonstration)

The Centers for Medicare and Medicaid Services approved the state’s Risk Mitigation Waiver in March 2022.

About the demonstration:

The Centers for Medicare & Medicaid Services (CMS) developed a new section 1115(a)(2) demonstration opportunity available to states under title XIX (Medicaid) of the Social Security Act, and pursuant to the demonstration opportunity outlined in State Medicaid Director Letter (SMDL) #20-002. The new demonstration opportunity would test whether, in the context of the current COVID-19 public health emergency (PHE), an exemption from the regulatory prohibition in 42 CFR § 438.6(b)(1) promotes the objectives of Medicaid. Specifically, this exemption, using section 1115(a)(2) expenditure authority, would allow states to add or modify risk-sharing mechanism(s) after the start of the applicable rating periods as specified in states’ contracts with their Medicaid-managed care plans. Such an expenditure authority is expected to support states with making appropriate, equitable payments during the PHE to help maintain provider capacity and beneficiary access to care during this period. The authority would exempt, as necessary, states from compliance with the current requirements in section438.6(b)(1), until the end of the PHE. 

To see all documents related to this demonstration please visit the Idaho Risk Mitigation Demonstration Library.