Section 1115 Waiver for Additional Services and Populations (WASP)
(Formerly Basic Medicaid Waiver)
State Medicaid programs may request from the Centers for Medicare and Medicaid Services (CMS) a waiver(s) of certain federal Medicaid requirements that are found in the Social Security Act. A common public misconception is that any portion of the Medicaid program can be waived by CMS. In reality, only certain requirements can be waived.
The WASP is effective through December 31, 2016 and a renewal through December 31, 2019 is currently being considered at CMS. The WASP offers Standard Medicaid benefits to qualified individuals. Individuals are enrolled for 12 months of continuous eligibility without reporting monthly changes of income or resources. Individuals are no longer eligible if they are no longer Montana residents or become otherwise eligible for Medicaid. Individuals will remain enrolled if, at the time of redetermination every 12 months, they meet the same eligibility qualifications.
WASP Populations Covered
1. Individuals age 18 or older, with SDMI who qualify for or are enrolled in the state-financed Mental Health Services Plan, but are otherwise ineligible for Medicaid benefits and either:
- Have income 0-138% of the FPL and are eligible for or enrolled in Medicare; or
- Have income 139-150% of the FPL regardless of Medicare status (they can be covered or not covered by Medicare and be eligible).
2. Provide a 12-month continuous eligibility period for all non-expansion Medicaid-covered individuals whose eligibility is based on MAGI.
3. Individuals determined categorically eligible for ABD for dental treatment services above the $1,125 State Plan dental treatment cap.
In the past, this Waiver has also been called HIFA (Health Insurance Flexibility and Accountability Waiver) or MHSP Waiver. See the boxes at the left for past or future proposed changes to the WASP.
Montana Medicaid and Healthy Montana Kids Plus Member Guide – Benefit Coverage
The Montana Medicaid Member Guide is a great place to see the general services for Standard Medicaid benefits. The chart of benefits in the guide shows most covered services. In general and if medically necessary, benefits like doctor, clinic, inpatient/outpatient hospital, prescription drugs, family planning, home health services, hospice, nursing home, lab, mental health services, OB, OT, PT, ST, social worker, substance dependency non hospital outpatient, surgery, and non-emergency transportation (to list a few examples), are covered for Standard Medicaid benefits. See the Montana Medicaid and Healthy Montana Kids Plus Member Guide for more information.
Please direct any eligibility or benefit questions regarding individuals who qualify for the MHSP Waiver population in the WASP to:
DPHHS, Addictive and Mental Disorders Division
PO Box 202905
Helena, Montana 59620-2905
(406) 444-4927 or at JenFox@mt.gov
Please direct any questions or comments about the WASP to:
DPHHS, Health Resources Division
PO Box 202951
Helena, Montana 59620-2951
(406) 444-6868 or at Lskilesfirstname.lastname@example.org