CMS seeks to increase transparency of waiting lists for 1915 (c) waiver programs
For eligible individuals hoping to be enrolled in Medicaid home- and community-based services (HCBS) waiver programs, the time spent on waiting lists can feel like an eternity.
And, it turns out, many states operate waitlists for section 1915(c) waiver programs even though those programs are not full to the federally approved limit or cap for those states’ waiver programs. That means, essentially, people are waiting in line to enter a room that is not full.
In light of this, the U.S. Centers for Medicare & Medicaid Services (CMS) has some ideas on how to increase transparency in the management of waiting lists across states and Medicaid HCBS waiver programs. In the latest proposed rule from the agency meant to increase access to care, CMS stated it wanted to more “adequately oversee and monitor state’s use of waiting lists.” If the rule proceeds as currently written, states will have to routinely report on waiting list activity.
As CMS noted in the justification for the waitlist reporting requirement, there are disparities in even the ways states manage their lists. According to CMS, some states will place interested individuals on lists before screening them for eligibility for services. This means that some waitlists are longer than they should be because there are people on them that would not be eligible for services if a spot opened in a waiver program for them.
“We have not previously required States to submit any information on the existence or composition of waiting lists, which has led to gaps in information on the accessibility of HCBS within and across States,” the CMS noted in the rule.
The CMS proposed rule was open for comment for several months before a July 3 deadline. In a joint statement from ADvancing States, the National Association of State Directors of Developmental Disabilities Services (NASDDDS), and the National Association of Medicaid Directors (NAMD), the organizations questioned whether waitlist management was the right place to require additional administrative work and state resources. They urged CMS to consider if that time and those resources would be better spent on other tasks related to increasing access to care.
Alternatively, other organizations applauded the proposed measure.
“This will provide sorely needed transparency to a system that people often spend years waiting on for critical care,” the United States of Care, an organization dedicated to increasing access to healthcare, commented.
According to recent data from the Kaiser Family Foundation, more than half a million people are on waiting lists for Medicaid HCBS programs across the U.S.
A Waitlist Module in Case Management Solutions
At FEI Systems, our comprehensive case management solutions are designed to assist our state partners with HCBS program management through every step of an individual’s lifecycle in the system. From intake to case closure, our case management solutions track data and activity against person-centered care plans developed to meet an individual’s unique needs.
Our case management solutions include a waitlist module as well. Since each waiver within states has a preset number of available slots for enrollees, our waitlist management module allows our partners to maintain the backlog of people waiting to apply for their waivers. As individuals are moved off the waiting lists, either through program enrollment or being deemed ineligible for services, our system updates the waiting list registry.
We are committed to supporting our state partners if this new CMS proposed rule is implemented as it stands. We have the expertise and experience in federal reporting to help our partners meet new CMS desired reports on waiting list activity.
