Medicaid programs provide health care services for the most vulnerable members of the community—including individuals with long-term needs who reside in nursing facilities or rehabilitation hospitals. Some states turn to home and community-based services (HCBS) waivers to set aside some Medicaid rules so that individuals can receive necessary services in their homes or other community (non-facility) setting.
HCBS waivers permit Medicaid programs to implement, test, and fine-tune innovative care delivery models that differ from standard practice, while also controlling costs. For individuals with mental illness, intellectual, and/or physical disabilities, HCBS waivers can be a lifeline—a way to receive services in the least restrictive setting, while protecting their dignity and independence.
We help Medicaid programs develop and implement flexible community-based waivers that improve the capacity to deliver care, consistent with current law and regulations. When necessary, we provide strategic consultation on waiver and Centers of Medicare and Medicaid Services requirements.
Waiver implementation
Our experienced team helps Medicaid programs implement HCBS waivers by handling enrollment, clinical eligibility, and provider network functions. Our waiver specialists:
- Process all incoming applications for eligibility based on minimum qualifications and requirements
- Provide in-person clinical assessments to determine the appropriate setting of residence and needed residential supports
- Support claims processing for waiver providers
- Engage in provider outreach and training to maximize implementation
Our waiver implementation services turn plans into action, delivering positive results in terms of clinical outcomes and cost controls.
Experience matters
Our waiver development and implementation team brings a wealth of knowledge and expertise to our clients, helping implement clinical eligibility and case management services for individuals accessing HCBS waivers. We have helped create more than 2,000 person-centered care plans facilitating transitions from nursing facilities and rehabilitation hospitals to care in community-based settings.
Our team collaborates with clients to build the supporting infrastructure for provider network administration, including provider recruitment, training, credentialing and re-credentialing activities, and performance management. We process more than 400,000 waiver service claims annually, representing a total of more than $45 million in Medicaid service dollars.