Medicaid Waivers & 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:

 

1. Substance Use Disorder Serious Mental Illness and Serious Emotional Disturbance Treatment and Recovery Access (SUD SMI SED TRA) demonstration, formerly known as the Substance Use Disorder Treatment and Recovery Access (SUD TRA) demonstration

NH Department of Health and Human Services (DHHS) is applying for an extension to its Section 1115(a) Research and Demonstration Waiver from the Centers for Medicare and Medicaid Services (CMS) for a period of an additional five years. This extension would enable DHHS to claim federal reimbursement for payment of services provided to Medicaid beneficiaries as described below:

  • Beneficiaries under age 65 who are otherwise eligible and primarily receiving treatment and withdrawal management services for substance use disorder (SUD) who are short-term residents in facilities that meet the definition of an institution for mental diseases (IMD);
  • Beneficiaries ages 21-64 who are otherwise eligible and primarily receiving short-term inpatient psychiatric treatment or short-term residential mental health treatment for serious mental illness (SMI) in an IMD; and
  • Beneficiaries who are otherwise eligible and receiving SUD, SMI or Serious Emotional Disturbance (SED) treatment while an inmate of a public institution within NHDOC’s system of state prisons, for a tailored package of care coordination services to be provided during the period 45 days prior to release (Tailored Medicaid Services to Support Successful Community Reentry or “Community Reentry”).

For more information on the public hearings, read the public notice.

Related Documents

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 based clinical treatment guidelines.  

On June 2, 2022, the Department received approval from the Centers for Medicare and Medicaid Services (CMS) to amend the Substance Use Disorder Treatment and Recovery Access Section 1115(a) Research and Demonstration Waiver. The approved amendment increases access to treatment for Medicaid beneficiaries with serious mental illness (SMI) and helps reduce the number of people waiting in hospital emergency departments (EDs) for a mental health bed. The amended waiver allows the New Hampshire Medicaid Program to pay for short-term stays in IMDs provided to Medicaid beneficiaries between ages 21-64 with SMI and approved for full Medicaid benefits.   

 

    2.  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.  

     

    3.  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). 

    1. In Home Support (IHS) Waiver for Children with Developmental Disabilities 
    2. Developmental Disabilities (DD) Waiver
    3. Acquired Brain Disorder (ABD) Waiver
    4. Choices for Independence (CFI) Waiver