Experts weighed in on Washington’s Section 1115 Medicaid Transformation Project (MTP) waiver and the availability of new services it will offer residents at the Inland Northwest State of Reform Health Policy Conference last week.
The Centers for Medicare & Medicaid Services (CMS) recently approved the Washington State Health Care Authority’s (HCA) request to extend and amend its MTP waiver. The extension will allow the state to implement new programs using federal Medicaid funds to improve Apple Health (Washington’s Medicaid program).
“Not everything was approved, but we see it as a success,” HCA MTP Director Chase Napier said. “There are a few programs we’re going to keep talking with CMS about. We are thrilled with what was approved.”
CMS denied Washington’s request to cover postpartum care for non-citizens. The state therefore cannot use waiver funds to support the initiative, but plans to use other funding resources to provide postpartum care for non-citizens.
The waiver extension will allow for re-entry coverage for individuals who are leaving a jail or prison and re-entering communities. The program will provide pre-release services up to 90 days prior to an individual’s expected date of release from a jail or prison.
“Re-entry is a part of our system that is as fragmented as you can get,” HCA Assistant Director of Medicaid Programs Jason McGill said. “This waiver starts to get at how we can connect that pre-release period with services in the community. It starts to get services in jails for people who need it. It is not a full-coverage benefit. It is a targeted, limited benefit. But it gets at a lot of the gaps in the system that we clearly see today.”
The waiver provides for a mandatory and a secondary set of benefits, McGill said. Some mandatory benefits include pre-release care coordination and medication-assisted treatment (MAT).
“The secondary set of services is really intriguing too, particularly the full set of pharmacy benefits. Not just pharmacy for MAT, but the full pharmacy formulary. Pharmacy formulary has to be the Medicaid formulary. It’s not only the drug, but the treatment.”
— McGill
Caitlin Safford, plan chief of staff at Amerigroup Washington, said the re-entry program will be intense from a managed care organization (MCO) perspective.
“We’ve been working with jails, all the MCOs have,” Safford said. “We work together as MCOs to connect with every jail in our state. We have also been trying to connect with the tribal jails where we’re able to. And that’s our next process. We have a wonderful process with the Department of Corrections.”
The program will represent a major change in the state’s healthcare system, Safford said.
“But this is the missing piece,” Safford said. “Having and being able to do Medicaid [services for individuals] actually in jail is going to be incredible. We’re trying to think about what infrastructure investments we need to make internally to be able to work with jails on a one-to-one basis. We’re looking forward to being able to help guide jails through this process.”
Courtney Smith Jiles, chief strategy officer at the Washington Association for Community Health, discussed the program from the perspective of federally qualified community health centers (FQHCs). The association represents 27 FQHCs in the state.
“Our health centers are some of the most qualified centers to be able to provide services for these folks just coming out of jails. And, frankly, to anyone with a health-related social need. I feel very proud to work on behalf of FQHCs because I have not seen a group of people who take every single opportunity to connect with [their] community in the way that they do.”
— Smith Jiles
McGill said the state’s initial plan is for prisons and jails to begin offering services in July 2025. They will have to complete a readiness review first, which includes ensuring access to medications and drug prescriptions.
“All these things have to be done in order to make sure a jail or a prison facility is ready,” McGill said. “We’re planning for a year in advance of that July 2025 timeline to build capacity funding opportunities for our local jails and prisons. And, fortunately, we do have significant funding for that through the waiver to help with those supports.”
The waiver extension will also allow for programs that address health-related social needs (HRSN), including community-based payment through community/Native hubs, rental subsidies for up to six months, and HRSN services for nutrition, housing, medical respite, and transportation. Napier discussed the six-month rental subsidies.
“Of course, we wanted more than six months and are going to continue that conversation with CMS. But we’re thrilled we were able to get six months as a starting point.
— Napier
Safford also spoke about the waiver’s housing component, as Amerigroup serves as a contractor for some related services, including community support services.
“When we started this program, the housing component started really slow,” Safford said. “That has really shifted, and we have seen, even in just the last year, a significant increase in assessments for supportive housing going up. Which leads to those people being able to access the services. We have a fantastic network of providers. We’re still adding providers to the services network.
When we think about the new components of the waiver, we really see it from a supportive housing standpoint. We’ve had these supportive housing services for five years. And we’ve seen the impact they’ve made. And the legislature added in transition assistance. That transition assistance led to people being able to get into a place to rent. Having first and last month’s rent, having help with utilities, having help with moving costs, that was always identified as a major barrier, even if they had access to supportive housing services themselves.”