Federal waivers allow states to offer and test new ways to deliver and pay for health care services. The Minnesota Department of Human Services (DHS) has applied for or received approval of the following waivers from the federal Centers for Medicare & Medicaid Services (CMS).
The Substance Use Disorder (SUD) waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) on Aug. 16, 2019, and is effective from July 1, 2019, through June 30, 2025. The SUD waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.
DHS submitted an extension request to CMS on Dec. 21, 2023, to continue the waiver for a five-year period beginning July 1, 2024. On May 30, 2024, CMS provided a temporary extension that continues the operational terms of the waiver through June 30, 2025. The temporary extension of the waiver does not impact people receiving services or providers. DHS anticipates that CMS will complete its review of the waiver extension request (submitted in December 2023) during the temporary extension period.
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. The waiver authorizes federal Medicaid matching funds for residential programs that have been determined as Institutions for Mental Diseases. 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 Documents and Reports
Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and are specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.
The Prepaid Medical Assistance Project Plus (PMAP+) waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) in July 1995. The PMAP+ waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.
On Nov. 15, 2023, CMS approved Minnesota’s request to extend the waiver from Jan. 1, 2024, through Dec. 31, 2028.
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 is pending and the determination process could take several months.
Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and are specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.
DHS posts reports as they are approved by CMS. DHS archives reports from prior demonstration years. Email dhspfr.federalrelations@state.mn.us to request an archived report.
PMAP+ Demonstration Year 24 (July 1, 2018 - June 30, 2019)
The Reform 2020 waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) on Oct. 18, 2013. The Reform 2020 waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.
On Jan. 31, 2020, CMS approved Minnesota’s request to extend the Reform 2020 waiver through Jan. 31, 2025. DHS is submitting a demonstration waiver extension request to CMS to continue the waiver for a five-year period beginning Feb. 1, 2025. The extension request is expected to be submitted to CMS in July 2024.
The Reform 2020 waiver provides federal financial support for the Alternative Care program. This program provides home and community-based support to help older adults with lower income, who are at risk of nursing home placement, stay in their homes.
Reform 2020 Waiver Documents and Reports
Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.
DHS posts reports as they are approved by CMS. DHS archives reports from prior demonstration years. Email dhspfr.federalrelations@state.mn.us to request an archived report.
Reform 2020 Demonstration Year 7 (July 1, 2019 - June 30, 2020)
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.
DHS submitted the Indian Health Board (IHB) of Minneapolis Section 1115 waiver request to CMS on Jan. 13, 2017. 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.
This section includes information about the public comment process, requesting documents, comment periods and public forums.
Public comment process
Public comment periods for waivers are posted in this section. DHS must receive your comments by the posted deadline.
Email comments about waiver amendments or extensions to Section1115WaiverComments@state.mn.us. DHS requests comments be submitted in Microsoft Word format or incorporated within the email text to support making comments available to people who use screen readers. 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. Email Section1115WaiverComments@state.mn.us to request a copy be mailed, or to pick up a copy. 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
Comment periods for waiver documents
Information about waiver documents available for review and comment is posted in this section in advance of submission to CMS.
No waiver documents are currently posted for public comment.
Comments for public forums
Information about participation in public forums is posted in this section 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 MSC+ waiver operates in combination with Minnesota’s 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.
DHS submitted a revised waiver amendment request to the Centers for Medicare and Medicaid Services (CMS) on Nov. 30, 2023, to add Community First Services and Supports (CFSS) to MSC+. CMS approved the amendment on Feb. 27, 2024, with an effective date of June 1, 2024. DHS submitted an amendment to CMS on June 13, 2024, to change the effective date of CFSS from June 1, 2024, to Oct. 1, 2024. There were no additional substantive revisions to the content of the waiver request approved by CMS on Feb. 27, 2024.
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 under Medicaid 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
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.