What you need to know about Medicaid waivers

Medicaid health coverage typically is for families eligible for government assistance through the former Aid for Families with Dependent Children (AFDC) program; pregnant women; or permanently disabled people.

The Personal Responsibility and Work Oppor tunities Act of 1996 replaced AFDC with a block grant program called Temporary Assistance for Needy Families (TANF). Families eligible for TANF are eligible for Medicaid.

About 20 states either have or are in the process of implementing section 1115a Medicaid waivers that provide more flexible Medicaid eligibility requirements. Some states permit people who meet income requirements but are not considered disabled by AIDS or other diseases to receive Medicaid coverage. Massachusetts is the first state to request a waiver solely for the inclusion of people with HIV.

These waivers basically permit states to be more flexible in providing Medicaid benefits through the implementation of a research and demonstration project. Most of these projects involve providing Medicaid through managed care plans.

The Baltimore-based Health Care Financing Administration adopted rules in 1994 that made it easier for states to obtain 1115a Medicaid waivers. Arizona has had a waiver since 1982, but all the others were implemented in the mid-to-late 1990s.

Some states, like Tennessee, have expanded Medicaid coverage to all people who are uninsured through the 1115a waiver.