An overview of waivers made possible by Section 1115 of the Social Security Act and Section 1332 of the Affordable Care Act. It explains spending and waiver authority and the legal considerations that may arise, the ways that states have used waiver authority, and reviews the limitations and new responsibilities that come with waivers. 

Learn the strategies required to deliver patient-centric, quality care for individuals with complex care needs. Successful coordination and management requires networking with multiple care providers and linking each intervention to the individual’s overall care.

Even with health insurance gains, access may still be an issue. State Innovation Waivers offer an opportunity to build on the Affordable Care Act and increase health insurance affordability. States can ask the federal government for authority to change parts of the ACA to achieve their goals.

The Care Transformation Collaborative of Rhode Island (CTC), a patient-centered medical home initiative managed by UMass Medical School, explains how primary care practices can build a medical neighborhood by creating a community health team to provide behavioral health and social support services to patients with high-cost, complex care needs.

Many individuals with disabilities are interested in working, but don’t know how doing so will affect their ability to receive public benefits like Social Security and Medicare. Work Without Limits was established in 2000 to provide Massachusetts residents who receive public benefits with information to help them make informed decisions about going to work.

Our customized, results-oriented high-risk medication program dramatically reduced refills for this Medicare Part D client with targeted prescriber outreach. This indicates discontinuation of the prescription or change to a safer medication.

Women with disabilities are at risk for poor birth outcomes. Little is known about specific potentially disabling health conditions and their effects on pregnancies. We found that disability risk identified through hospital claims is associated with poor infant and maternal outcomes.

How mapping and visualization tools can enhance the use of data to characterize a population’s health and social services needs, target interventions and compare outcomes across population subgroups. These tools are used to manage Massachusetts 1915c Medicaid Waiver programs, track operations, improve efficiency, report quality measures, monitor program integrity and plan for  service needs.

Integration strategies and coordination benchmarks within the Massachusetts Medicaid Management Information System (MMMIS) are used to ensure accurate Medicaid and Medicare enrollment; fully engage service delivery options (including managed care and integrated care programs); and effectively cost-avoid, reprice, or cost-share to ensure the state’s lowest payment liability.

This report describes the process of providing integrated care for patients with substance use disorders at three sites in central Massachusetts: Edward M. Kennedy Community Health Center, Family Health Center of Worcester, and Community Healthlink. It identifies common practices that improve care coordination and presents key findings.