What You Need to Know About Section 1115 Waivers

One of the most important new rules that was brought out of the Patient Protection and Affordable Care Act was the expansion of Medicaid coverage to many non-elderly adults. Those whose income was at or below 138% of the federal poverty level could not potentially qualify for certain coverages. The section that addressed this new coverage was #1115, which is why this coverage is commonly sought with a “1115 waiver.” This was validated further in June 2012 by the US Supreme Court, which confirmed that this was an option for states to implement.

Soon after the decision, many states began offering this as an option, and those who wanted the coverage would have to fill out a 1115 waiver to get approved. Florida first proposed adding this coverage in August 2005, and it was approved in October of the same year. These waivers were then implemented in July 2006 and have been extended several times over the past several years.

Who Qualifies
Florida has implemented this coverage according to a tiered system based on age, disabilities, and other factors. The basic groups are as follows:

  • Infants Under the Age of 1 – Family must earn no more than 206% of the federal poverty level.
  • Children 1-5 – Must earn no more than 140% of the federal poverty level.
  • Children 6-18 – Can earn no more than 133% of the federal poverty level.
  • Blind or Disabled Children – Eligible under the existing Supplemental Security Income qualifications.
  • Pregnant Women – Income can’t exceed 191% of the federal poverty level.

There are others who may qualify for this added coverage based on age and other factors. Many people who qualified for some type of SSI coverage will also qualify for additional Medicaid coverage after getting their 1115 waiver approved.

There are a variety of benefits provided to those who are approved to the program. Under this system, people are able to get a more customized set of benefits that are typically different from (but not less than) those that are offered through the Florida State plans. These benefits can include Healthy Behavior Programs, which reward participants for healthy choices, and more.

Qualify Today
If you believe you may qualify for the added coverage that is possible through the 1115 waiver, you want to make sure you get through the application and evaluation process successfully. Contact ProActive Legal Care to discuss your situation, and we’ll let you know if seeking this waiver makes sense in your situation. If so, we’ll be there to help you through the entire process.

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