Medicaid Waivers and Demonstrations

There are several waiver and demonstration programs in NH Medicaid. Below are the links and descriptions of those programs.

1115 Demonstration

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that are found by the Secretary to be likely to assist in promoting the objectives of the Medicaid program. The purpose of these demonstrations, which give the Department additional flexibility to design and improve our programs, is to demonstrate and evaluate state-specific policy approaches to better serving Medicaid populations. Section 1115 demonstrations are approved for an initial five-year period and can be extended for up to an additional three to five years, depending on the populations served. The Department has three 1115 Demonstrations:

Substance Use Disorder Treatment and Recovery Access (SUD TRA)
This demonstration provides the Department with authority to provide high-quality, clinically appropriate SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an Institution for Mental Diseases (IMD). It also builds on the state’s existing efforts to improve models of care focused on supporting individuals in the community and home, outside of institutions and strengthen a continuum of SUD services based on the American Society of Addiction Medicine (ASAM) criteria or other nationally recognized assessment and placement tools that reflect evidence[1]based clinical treatment guidelines.

Building Capacity for Transformation
On January 5, 2016, the Centers for Medicare and Medicaid Services (CMS) approved New Hampshire’s application for a five-year Medicaid Building Capacity for Transformation demonstration project which concluded on December 31, 2020. This demonstration represented an opportunity for New Hampshire to strengthen community-based mental health services, combat the opioid crisis, and drive health care delivery system reform. Through this demonstration, the state pursued improved access to and quality of, both the behavioral health services and physical health services of those with behavioral health diagnoses including both mental health and substance abuse disorders. The demonstration enabled the establishment of regionally-based Integrated Delivery Networks (IDNs) that consisted of behavioral health and other health care and community providers. These providers worked collaboratively to develop a sustainable, integrated behavioral and physical health care delivery system in New Hampshire.  

New Hampshire Granite Advantage Health Care Program
This demonstration provided the Department with the authority to test an approach to promoting community engagement and work by instituting community engagement requirements as a condition of Granite Advantage eligibility. Granite Advantage beneficiaries in the new adult group must work or engage in other specified activities, including vocational educational training, job training, or job search activities, for at least 100 hours per month to maintain eligibility for coverage in the new adult group, unless they meet exemption criteria established by the Department or demonstrate good cause for failing to meet the community engagement requirements. If Granite Advantage beneficiaries failed to meet these requirements for two consecutive months, their Medicaid eligibility would have been suspended.  The Granite Advantage Health Care Program demonstration is not enforceable at this time. 

1915(b) Waiver

Section 1915(b) of the Social Security Act provides the Department with the flexibility to modify its delivery systems by allowing CMS to waive statutory requirements for comparability, statewideness, and freedom of choice. The 1915(b) application requires the Department to show that the Section 1915(b) waiver will be cost effective, meaning that its use will not cause expenditures to be higher than they would have been without the waiver. Section 1915(b) waivers are initially approved for two years, with renewals of up to two years. In the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), Congress authorized the Secretary to approve Section 1915(b) for five years if they enroll individuals dually eligible for Medicare and Medicaid. The Department has one 1915(b) waiver.

Mandatory Managed Care for State Plan Services for Currently Voluntary Populations

The Department’s 1915(b) waiver mandates enrollment in the managed care delivery system for Medicaid beneficiaries who could previously elect to receive their state plan services through the fee-for-service delivery system, pursuant to 42 CFR 438.50(d)(1-3). 

1915(c) Home and Community Based Waivers

Section 1915(c) of the Social Security Act permits the Department to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. To be eligible, individuals must meet level-of-care requirements—that they would require institutionalization in the absence of Home and Community Based Care Services. Coverable HCBS are the services needed to avoid institutionalization; these include services such as, case management, personal care, adult day health, habilitation, and respite care. 1915(c) HCBS waiver services complement and/or supplement the services that the Department offers under its State plan. Waiver participants must have full access to State plan services, including Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services when children participate in a waiver. Because a separate Section 1915(c) waiver is generally required for each eligible population, the Department operates four HCBS 1915(c) waivers, which are managed by the Division of Long-Term Supports and Services (DLTSS).