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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).
CMS announced an option in April 2023 allowing states to provide Medicaid covered services in correctional facilities under a section 1115(a) waiver of the Social Security Act. CMS stated that expanded access to services to people while incarcerated will improve health outcomes and reduce repeating offenders. Medicaid cannot be used to cover services in correctional facilities without a section 1115(a) waiver. The 2024 Minnesota legislature authorized DHS to request a waiver. State law identifies the services to be covered, the eligible populations, the correctional facilities included, and how public input will be sought. Refer to Minnesota Statutes, 256B.0761 for more information.
DHS, in collaboration with the Minnesota Department of Corrections (DOC), developed a Reentry waiver application that seeks to improve health outcomes, reduce deaths, decrease repeat offense rates, and address related disparities for people who have been incarcerated. Minnesota will provide a set of Medicaid covered services to eligible participants within 90 days of release to achieve these outcomes. The waiver application was posted for a 30-day public comment period and two public hearings were held in December 2024 to provide DHS with feedback about the application. The comments and feedback, and DHS’ responses were included in the final application submitted to CMS.
DHS submitted the Reentry waiver application, with the cost and enrollment projections, to CMS on Jan. 16, 2025.
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.
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.
Design Plans and Evaluation Reports
Quarterly and Annual Reports
DHS posts reports as they are approved by CMS.
SUD Demonstration Year 1 (July 1, 2019-June 30, 2020)
SUD Demonstration Year 2 (July 1, 2020-June 30, 2021)
SUD Demonstration Year 3 (July 1, 2021 - June 30, 2022)
SUD Demonstration Year 4 (July 1, 2022 - June 30, 2023)
SUD Demonstration Year 5 (July 1, 2023 - June 30, 2024)
SUD Demonstration Year 6 (July 1, 2024 - June 30, 2025)
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:
DHS submitted an amendment to CMS on Jan. 25, 2024, to provide Medicaid coverage for former foster care youth up to the age of 26. The CMS review is pending. This group is covered by Medicaid through June 30, 2025.
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.
Design Plans and Evaluation Reports
Quarterly and Annual Reports
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)
PMAP+ Demonstration Year 25 (July 1, 2019 - June 30, 2020)
PMAP+ Demonstration Year 26 (July 1, 2020 - June 30, 2021)
PMAP+ Demonstration Year 27 (July 1, 2021 – June 30, 2022)
PMAP+ Demonstration Year 28 (July 1, 2022 – June 30, 2023)
The Reform waiver was first approved under the title “Reform 2020: Pathways to Independence” by the Centers for Medicare & Medicaid Services (CMS) on Oct. 18, 2013. The title was changed from “Reform 2020: Pathways to Independence” to “Reform: Pathways to Independence” as part of the extension request approved by CMS on Jan. 2, 2025. The Reform 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 waiver through Jan. 31, 2025. DHS submitted an extension request to CMS on Aug. 2, 2024, to continue the waiver for a five-year period beginning Feb. 1, 2025. On Jan. 2, 2025, CMS approved Minnesota’s request to extend the waiver from Feb. 1, 2025, through Jan. 31, 2030.
The Reform 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.
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.
Design Plans and Evaluation Reports
Quarterly and Annual Reports
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)
Reform 2020 Demonstration Year 8 (July 1, 2020 - June 30, 2021)
Reform 2020 Demonstration Year 9 (July 1, 2021 – June 30, 2022)
Reform 2020 Demonstration Year 10 (July 1, 2022 – June 30, 2023)
Reform 2020 Demonstration Year 11 (July 1, 2023 – June 30, 2024)
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 applications, 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 applications, 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.
No public forums are currently scheduled.
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.
The current MSC+ waiver expires June 30, 2026. Review the MSC+ Waiver and CMS Approval letter (PDF) for more information.
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.
Refer to the MSC+ waiver amendment (PDF) for a copy of the amendment request, and MSC+ budget neutrality spreadsheet for budget neutrality information.
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:
The current Case Management waiver expires March 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 notifications when new information is available about Medicaid waivers, such as the Reform 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).
