Adult family home operators may begin to hear more about the state’s application for a 1915(i) waiver. This article is intended to provide some information about why this is happening and what it may mean for providers and residents.
What is a 1915(i) waiver?
1915(i) refers to a specific section of the Social Security Act outlining the rules for Medicaid programs serving the elderly and disabled. A 1915(i) waiver is a way the state access Medicaid funds in partnership with the federal government. Most AFH residents in AFHs receive their Medicaid funds through a 1915(k) state plan, sometimes called Community First Choice. This program allows states to share Medicaid costs with the federal government for specific services. The services are typically limited to personal care.
Why is Washington seeking this waiver?
The state is applying for the 1915(i) waiver in part because it will allow the state to receiving federal funding for services related to behavioral supports, such as increased supervision. Currently, ETRs and other behavioral wrap around services are funded by state only dollars. This federal partnership will reduce costs in Washington and may allow for more and expanded services.
What does this mean for AFH providers?
The 1915(i) waiver is intended to replace the current behavior wrap around services. Sometimes these are referred to as “MCO ETRs” or Community Behavioral Health Supports (CHBS). The state has targeted July 1, 2023 to begin these services. However, before the state can implement this program, , the Health Care Authority is still waiting for legislative funding to implement the program. Additionally, the state is required to negotiate with the AFH Council regarding the rate and manner of reimbursement. The state and Council have been engaged in negotiations for almost one year. These negotiations have been complicated as the state has also been paying for some these services without appropriately engaging the Council. This has lead to the Council filing an unfair labor practice against the state.
What remains to be negated are issue around the rate and manner of payment. We think these new rates need to also be considered in bed hold calculations. Also we are seeking clarification on the eligibility for residents and providers. This bargaining will continue and we will do our best to keep you up to date about any decisions, trainings, or opportunities to participate. In the end, this will be a new revenue source to support the residents in our care with significant mental or behavioral health needs.
Please reach out to the Council with any questions.