According to CMS (2018), Medicaid waivers can be used by states to waive certain Medicaid

program requirements to allow the state to provide care for people who might not otherwise
be eligible under Medicaid. In essence, these waivers allow for State Medicaid Plans (SPA’s)
to make programmatic or operational changes to their Medicaid program to better meet the
needs of their beneficiaries
An SPA is an agreement between state and the federal government that describes how care
will be delivered and reimbursed under the Medicaid program. The agreement ensures that the
state will follow all federal rules and guidelines to claim funding. “The state plan sets out
groups of individuals to be covered, services to be provided, methodologies for providers to be
reimbursed and the administrative activities that are underway in the state” (Medicaid, n.d., para
1).
HCBS 1915 waiver programs can help states target where people are in need of supports and
services. According to CMS (2018), all HCBS 1915 waiver programs are authorized under
Section 1915 of the Social Securities Act, are fee-for-service programs, meaning that the
provider is paid for each service the patient receives, and requires individuals to meet criteria
that are set by the state and based on a person’s level of need. Other waivers include the
1915(c) that are service based, 1915(i) that are income based on income guidelines, and
1915(j) waivers that are self-directed personal assistance services that allow patients to have
more active roles in the services they receive.
Waivers can be used to expand care to vulnerable patients under the State Medicaid Plan and
help ensure quality care.
CMS. (2018, April 20). State Medicaid Plan and Waivers. Retrieved from
https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/LTSS-
TA-Center/info/state-medicaid-policies
Medicaid. (n.d.). SPA and 1915 Waiver Processing. Retrieved from
https://www.medicaid.gov/resources-for-states/spa-and-1915-waiver-processing/index.html