Medicaid Projects and 1115 Waivers
A body of federal regulations still prescribe state monitoring of the Medicaid program, which emphasizes error containment and, for states, avoidance of fiscal sanctions. In 1994 the Health Care Finance Administration aggressively promoted independent state approaches to monitoring the Medicaid program that states believe better serve state and federal needs. States implemented these initiatives are in lieu of prescribed federal monitoring, either under a federally approved state pilot, or as a federally approved 1115 Waiver. Either approach has the very significant advantage that states are not subject to federal fiscal sanctions during the period they are operating under an approved pilot or waiver. The majority of states now meet their monitoring requirements through approved projects, and many states have been operating under a pilot or waiver since that first year.
More than thirty states have implemented one or more Medicaid projects. Some states have reported remarkable success in identifying and correcting Medicaid policies or procedures that were error-prone, and a source of very high misspent claims dollars.
Based on successes nationwide, NAPIPM members and federal representatives of CMS urged all states to seriously consider implementing a federally approved alternative to the traditional Medicaid program.