Federal health care waivers

DHS submitted a demonstration waiver extension request to CMS to continue the waiver for a five-year period beginning July 1, 2024. The extension request was submitted on Dec. 21, 2023. Refer to SUD Section 1115 Waiver Demonstration Extension Request (PDF) to review the extension request. Refer to SUD Section 1115 Waiver Demonstration Summary (PDF) to review a summary of the extension request. The extension request included the Draft Interim Evaluation Report, July 2023 (PDF).

• SUD waiver approval, expenditure and waiver authorities, and special terms and conditions (PDF)
• SUD Section 1115 Waiver Implementation Plan (PDF)
• SUD Waiver Monitoring Protocol Part A (XLSX)
• SUD Waiver Monitoring Protocol Part B (PDF)
• SUD Waiver Evaluation Design Plan (PDF)

This demonstration project is an important component of the state’s larger reform effort to address the opioid crisis as well as transform the health care delivery system for Medicaid members who need substance use disorder treatment. State law directs DHS to implement the waiver to receive Medicaid matching funds for residential programs that have been determined as Institutions for Mental Disease. The demonstration waiver tests the impact of evidence-based provider referral arrangements and practices on improving health outcomes for Medicaid members with substance use conditions.

SUD Waiver Reports to CMS 

The SUD waiver special terms and conditions require the state to provide updates to CMS on the demonstration’s implementation. Reports are submitted on a quarterly and annual basis and are posted after they are approved by CMS.

SUD Demonstration Year 1 (July 1, 2019-June 30, 2020) 

• Quarterly Reports for Demonstration Year 1, Quarters 2 and 3 (PDF)
• Annual Report for Demonstration Year 1 (PDF)

SUD Demonstration Year 2 (July 1, 2020-June 30, 2021)

• Quarterly Report for Demonstration Year 2, Quarter 1 (PDF)
• Quarterly Report for Demonstration Year 2, Quarter 2 (PDF)
• Quarterly Report for Demonstration Year 2, Quarter 3 (PDF)
• Quarterly Report for Demonstration Year 2, Quarter 4 (PDF)

SUD Demonstration Year 3 (July 1, 2021 - June 30, 2022)

• Quarterly Report for Demonstration Year 3, Quarter 1 (PDF)
• Quarterly Report for Demonstration Year 3, Quarter 2 (PDF) from the U.S. government’s Medicaid website
• Quarterly Report for Demonstration Year 3, Quarter 3 (PDF) from the U.S. government’s Medicaid website 
• Annual Report for Demonstration Year 3 (PDF) from the U.S. government’s Medicaid website 

SUD Demonstration Year 4 (July 1, 2022 - June 30, 2023)

• Quarterly Report for Demonstration Year 4, Quarter 1 (PDF) from the U.S. government’s Medicaid website 
• Quarterly Report for Demonstration Year 4, Quarter 2 (PDF) from the U.S. government’s Medicaid website 
• Quarterly Report for Demonstration Year 4, Quarter 3 (PDF) from the U.S. government’s Medicaid website 

Evaluation reports 

The special terms and conditions require independent evaluation of the SUD waiver. The following reports are approved by CMS.  

• Demonstration Year 2, Mid-Point Assessment: Minnesota Substance Use Disorder System Reform Section 1115(a) Demonstration Project, Report March 2022B (PDF) (CMS-approved document with updates for accessibility)
• Draft Interim Evaluation Report, July 2023: Minnesota Substance Use Disorder System Reform Section 1115(a) Demonstration Project Evaluation (PDF) (to be submitted to CMS with the waiver extension request)

The PMAP+ waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) in July 1995.

On Nov. 15, 2023, CMS approved Minnesota’s request to extend the waiver from Jan. 1, 2024, through Dec. 31, 2028. The updated PMAP+ waiver approval, expenditure and waiver authorities, and special terms and conditions is expected to be posted in February 2024.

The PMAP+ waiver provides federal authority to: 

• Cover children under Medical Assistance who are 12 to 23 months old with income eligibility above 275% and at or below 283% of the federal poverty level (FPL).
• Waive the federal requirement to redetermine the basis of Medical Assistance eligibility for caretaker adults with incomes at or below 133% of the FPL who live with children age 18 who are not full-time secondary school students.
• Provide Medical Assistance benefits to pregnant people during the period of presumptive eligibility.

DHS submitted the following PMAP+ amendments to CMS on Jan. 25, 2024. The CMS review and determination process could take several months.

• Amendment for extended and expanded continuous Medicaid eligibility
• Amendment to provide Medicaid coverage for former foster care youth

PMAP+ waiver reports to CMS

The PMAP+ waiver special terms and conditions require the state to provide updates to CMS on the program’s implementation. Reports are submitted on a quarterly and annual basis and are posted after they are approved by CMS. Reports from prior demonstration years have been archived and can be made available by request by emailing dhs.waiver.comments@state.mn.us.

PMAP+ Demonstration Year 21 (July 1, 2015 - June 30, 2016)

• Quarterly reports for Demonstration Year 21 (PDF)
• Annual report for Demonstration Year 21 (PDF)

PMAP+ Demonstration Year 22 (July 1, 2016 - June 30, 2017)

• Quarterly reports for Demonstration Year 22 (PDF)
• Annual report for Demonstration Year 22 (PDF)

PMAP+ Demonstration Year 23 (July 1, 2017 - June 30, 2018)

• Quarterly reports for Demonstration Year 23 (PDF)
• Annual report for Demonstration Year 23 (PDF)

PMAP+ Demonstration Year 24 (July 1, 2018 - June 30, 2019)

• Quarterly reports for Demonstration Year 24 (PDF)
• Annual report for Demonstration Year 24 (PDF)

PMAP+ Demonstration Year 25 (July 1, 2019 - June 30, 2020)

• Quarterly report 1 for Demonstration Year 25 (PDF)
• Quarterly report 2 for Demonstration Year 25 (PDF)
• Quarterly report 3 for Demonstration Year 25 (PDF)
• Quarterly report 4 for Demonstration Year 25 (PDF)
• Annual report for Demonstration Year 25 (PDF)

PMAP+ Demonstration Year 26 (July 1, 2020 - June 30, 2021)

• Quarterly report 1 Demonstration Year 26 (PDF)
• Quarterly report 2 Demonstration Year 26 (PDF)
• Quarterly report 3 Demonstration Year 26 (PDF)
• Quarterly report 4 Demonstration Year 26 (PDF)
• Annual report for Demonstration Year 26 (PDF)

PMAP+ Demonstration Year 27 (July 1, 2021 – June 30, 2022)

• Quarterly report 1 Demonstration Year 27 (PDF)
• Quarterly report 2 Demonstration Year 27 (PDF)
• Quarterly report 3 Demonstration Year 27 (PDF) 
• Quarterly report 4 Demonstration Year 27 (PDF)
• Annual report for Demonstration Year 27 (PDF)

PMAP+ Demonstration Year 28 (July 1, 2022 – June 30, 2023)

• Quarterly report 1 Demonstration Year 28 (PDF)
• Quarterly report 2 Demonstration Year 28 (PDF)
• Quarterly report 3 Demonstration Year 28 (PDF)
• Quarterly report 4 Demonstration Year 28 (PDF)

The Reform 2020 waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) on Oct. 18, 2013.

On Jan. 31, 2020, CMS approved Minnesota’s request to renew the Reform 2020 waiver through Jan. 31, 2025. Review the Reform 2020 waiver approval, expenditure and waiver authorities, and special terms and conditions (PDF) for information about the CMS approval for Minnesota’s 1115 demonstration. DHS will submit a demonstration waiver extension request to CMS in June 2024 to continue the waiver for a five-year period beginning Jan. 31, 2025. You will be able to review and comment on the draft extension plan when it's posted under the Public Hearings and Comments section.   

The Reform 2020 waiver provides federal financial support for the Alternative Care program, which provides support to help older adults who are at risk of nursing home placement to stay in their home.

Reform 2020 waiver reports to CMS

The Reform 2020 waiver special terms and conditions require the state to provide updates on the program’s implementation to CMS. Reports are submitted on a quarterly and annual basis and are posted after they are approved by CMS. Reports from prior demonstration years have been archived and can be made available by request via dhs.waiver.comments@state.mn.us.

Reform 2020 Demonstration Year III (July 1, 2015 - June 30, 2016)

• Quarterly reports for Demonstration Year III (PDF)
• Annual report for Demonstration Year III (PDF)

Reform 2020 Demonstration Year IV (July 1, 2016 - June 30, 2017)

• Quarterly reports for Demonstration Year IV (PDF)
• Annual report for Demonstration Year IV (PDF)

Reform 2020 Demonstration Year V (July 1, 2017 - June 30, 2018)

• Quarterly reports for Demonstration Year V (PDF)
• Annual report for Demonstration Year V (PDF)

Reform 2020 Demonstration Year VI (July 1, 2018 - June 30, 2019)

• Quarterly reports for Demonstration Year VI (PDF)
• Annual report for Demonstration Year VI (PDF)

Reform 2020 Demonstration Year VII (July 1, 2019 - June 30, 2020)

• Quarterly report 1 Demonstration Year VII (PDF)
• Quarterly report 2 for Demonstration Year VII (PDF)
• Quarterly report 3 Demonstration Year VII (PDF)
• Quarterly report 4 Demonstration Year VII (PDF)
• Annual Report Demonstration Year VII (PDF)

Reform 2020 Demonstration Year VIII (July 1, 2020 - June 30, 2021)

• Quarterly report 1 Demonstration Year VIII (PDF)
• Quarterly report 2 Demonstration Year VIII (PDF)
• Quarterly report 3 Demonstration Year VIII (PDF)
• Annual and Quarterly Report 4 Demonstration Year VIII (PDF)

Reform 2020 Demonstration Year IX (July 1, 2021 – June 30, 2022)

• Quarterly report 1 Demonstration Year IX (PDF)
• Quarterly report 2 Demonstration Year IX (PDF)
• Quarterly report 3 Demonstration Year IX (PDF) 
• Annual and Quarterly report 4 Demonstration Year IX (PDF)

Reform 2020 Demonstration Year X (July 1, 2022 – June 30, 2023)

• Quarterly report 1 Demonstration Year X (PDF)
• Quarterly report 2 Demonstration Year X (PDF)
• Quarterly report 3 Demonstration Year X (PDF)

Waiver background

The 2016 Minnesota State Legislature directed DHS to seek federal waiver authority to allow tribal organizations to receive the Indian Health Services encounter rate for Medicaid services provided to American Indian and Alaskan Native populations. Only organizations that are dually certified as Urban Indian Health Programs and Federally Qualified Health organizations qualify. The Legislature also asked DHS to seek authority for the state to be eligible for 100% federal financial participation for such services. (Refer to Minnesota Statutes, 256B.0625, subdivisions 30 and 34.)

On Jan. 13, 2017, DHS submitted the Indian Health Board (IHB) of Minneapolis Section 1115 waiver request to the CMS. Currently, the IHB is the only entity eligible under this waiver authority, should it be granted by CMS. As a demonstration project under section 1115 of the Social Security Act, DHS plans to test new ways to help urban American Indians served by the IHB to access quality health care. This approach includes the use of an abbreviated application process for American Indians eligible for Medicaid and targeting additional funding for the IHB into enhanced care coordination and application assistance for this population.

The IHB waiver application was initially submitted to CMS on Jan. 13, 2017. A 30-day comment period on the initial IHB waiver application was held before submission, beginning on Dec. 12, 2016. The initial application was revised to include information on the research hypothesis and evaluation parameters related to the demonstration’s proposed goals. A 30-day comment period on the revised waiver application began on Apr. 17, 2017. The revised application was submitted to CMS on May 17, 2017.

Revised IHB Waiver Application (PDF)
Attachment D: Evaluation Plan (PDF)

Information about submitting comments or requesting copies of waiver materials

Amendments and extensions

Public comment periods for waivers are posted in this section. We must receive your comments by the posted deadline.

Email comments about waiver amendments or extensions to Section1115WaiverComments@state.mn.us. To support making comments available to people who use screen readers, DHS requests comments be submitted in Microsoft Word format or incorporated within the email text. If you would also like to provide a signed copy of a comment letter, you may submit a second copy in Adobe PDF format. Comments provided on paper or in an electronic format that cannot be converted for a screen reader may be reformatted to meet state accessibility requirements for posting. The original formatting and content will be kept as much as possible. For example, if graphics or tables are included, a description that can be read will be added. Comments received may be posted publicly.

Paper copies of amendments and extensions are available by request. To request a copy be mailed, or to pick up a copy, email your request to Section1115WaiverComments@state.mn.us. Mail your request or comments via the U.S. Postal Service to:

Minnesota Department of Human Services
Federal Relations – Medicaid Waivers
P.O. Box 64967
St. Paul, MN 55164-0967

Public forums

Information about participation in public forums is provided in advance of the forum, and comments are taken during the forum.

The MSC+ waiver allows Minnesota to require seniors to enroll in managed care to receive Medicaid services. This includes people who are dually eligible for both Medicaid and Medicare and who have not opted to enroll in Minnesota Senior Health Options (MSHO). The waiver operates in combination with Minnesota’s existing Elderly Waiver to enable the integration of community-based long-term care services into the managed care service delivery system. The waiver also provides federal authority to require certain populations eligible for Medical Assistance to enroll in managed care, including American Indians and children who are in foster care. 

The current MSC+ waiver expires June 30, 2026. Review the MSC+ Waiver and CMS Approval letter (PDF) for more information about the waiver and its approval.

The Case Management waiver allows Minnesota to continue to limit case management providers for the home and community-based waivers to counties and tribes under contract with DHS or their subcontractors. The waiver applies only to enrollees whose waiver services are covered fee-for-service and who receive services under one of the following Section 1915(c) home and community-based waiver programs:

• Developmental Disabilities Waiver (DD)
• Elderly Waiver (EW)
• Community Access for Disability Inclusion (CADI) Waiver
• Brain Injury Waiver (BI)
• Community Alternative Care (CAC)

The current Case Management waiver expires Mar. 31, 2027. Review the Case Management Waiver and CMS Approval Letter (PDF) for more information.

This is a free email subscription service that allows you to receive one-way email notification when new information is available about Medicaid waivers, such as the Reform 2020 waiver, the Prepaid Medical Assistance Plus (PMAP+) waiver, the Minnesota Senior Care Plus (MSC+) waiver and new waiver applications. Subscribers will receive emails when DHS is seeking public comment on items that will be submitted for federal approval, when requests for federal authority are submitted to the federal government, and when waiver requests have been approved or denied by CMS.

Information on Minnesota’s federal Medicaid waivers is also available on the CMS State Waivers List webpage (enter Minnesota in the search box).