HCFA streamlines waivers process

Frees states to serve certain patients

The Health Care Financing Administration (HCFA) in Baltimore has streamlined the process for states to obtain Medicaid home and community-based waivers for programs that target three populations: people with traumatic brain injury, people living with HIV/AIDS, and children who are medically fragile.

The new process is a way for HCFA to encourage states to serve these populations, says a HCFA spokeswoman. To develop prototype waiver applications for the programs, HCFA used common services and provider qualifications from the 10 to 15 states that currently have programs in place covering the three target populations. The applications establish qualifications and standards providers must meet to ensure cost-effectiveness and quality care.

States will be able to submit the prototype waiver applications for quick review and approval. The applications were produced in response to a request from the National Governors’ Association to make the process easier.

For private duty agencies that see the need for Medicaid waiver programs for these target populations in their states, the new process will make it easier for states to get their programs up and running. "This will reduce the bureaucracy, the red tape, and the work that’s actually done within the Medicaid offices that handle the waivers," says Matthew Salo, health policy analyst with the American Public Welfare Association in Washington, DC. To inquire about the status of such programs, he says, contact your state or local office that administers Medicaid programs.

The streamlined application process, however, might not entice states to create a waiver where isn’t much of a need for one. "[The prototype application] is sort of a recognition that certain kinds of waivers, like the [ones targeting] AIDS and the medically fragile children, are fundamentally very much the same from state to state," Salo says.

Home and community-based waivers allow states to provide home and community-based services to individuals who would otherwise be institutionalized. In the past, approximately 90 days were required to process a state’s request for a home and community-based waiver. With the submission of a prototype waiver application without modifications, a state is virtually assured that its waiver will be approved immediately. A state may modify aspects of the approved waiver program, such as the addition of services or provider qualifications, by submitting an amendment to its waiver. Amendments may be approved retroactively, allowing states to continue serving waiver clients while fine-tuning their waiver programs.

The waivers will be effective for three years, starting on the date of approval or on the date specified by the state.