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 was extended by CMS in 2023 and is now effective January 1, 2023 through December 31, 2027. Individuals are no longer eligible if they are no longer Montana residents or become otherwise eligible for Medicaid.

WASP Populations Covered

POPULATION 1

Individuals age 18 or older, with Severe Disabling Mental Illness (SDMI) who qualify for or are enrolled in the state-funded Mental Health Services Plan (MHSP), but are otherwise ineligible for Medicaid benefits and either:

• Have income 0-138% of the Federal Poverty Level (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).

Individuals will remain enrolled if, at the time of redetermination, they meet the same eligibility qualifications.

Benefit:  Qualified individuals are offered Standard Medicaid benefits and 12-months of continuous eligibility without reporting monthly changes of income or resources.

POPULATION 2

Individuals determined categorically eligible for Medicaid in the Aged, Blind, or Disabled (ABD) category.

Individuals will remain enrolled if, at the time of redetermination, they meet the same eligibility qualifications.

Benefit:  Dental treatment services above the $1,125 State Plan dental treatment cap. 

In the past, this Waiver has also been called Health Insurance Flexibility and Accountability Waiver (HIFA) or MHSP Waiver. See the boxes at the right 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:

Tracey Palmerton
DPHHS, Behavioral Health and Developmental Disorders Division
PO Box 202905
Helena, Montana 59620-2905
(406) 444-3187 or at tracey.palmerton@mt.gov 

Please direct any questions or comments about the WASP to:

Kial Leach
DPHHS, Health Resources Division
PO Box 202951
Helena, Montana 59620-2951
(406) 444-6868 or at KLeach@mt.gov