Waiver Reform: An

amendment to 42
U.S. Code Chapter
7, Social Security
Act(SSA) to provide
a federal waiver
option to alleviate
States current
funding crises which
occur nation-wide.
Commercial insurance policies

typically exclude nursing

benefits, placing a great burden
on individual states to provide
the institutional level of care as
a public benefit granted by
Medicaid waivers. Combined
with a lack of a nation-wide
standard for reimbursement
rates for nurses and
uncoordinated care, children
with medical complexities which

waiver that assists children with

The approach to creating

medical complexities; along with

special laws for special

mandates against private policies

needs is to save the

to allow waiver benefits, would

exorbitant expenses that are

benefit each 50 states, each

paid to institutional

having a number of waivers,

facilities, when the child can

combining federal and state

be safely cared for at home.

dollars.

Complicated by inadequate

Families are confused and

limited in the care of this
vulnerable population that
remains dependent for their
lifetime to the complex waiver
programs which vary state to
state. Children have been at great

access to health care, little

service availability, limited
insurance and financial
restraints, current
legislation limits this
growing population (Mentro,
2003).

risk of institutionalism because

of budgetary crises; and there
aren't many options for the
complex care of this
population if they cannot be
maintained at home (Nagle,
2014).

Special kids with special

survive on life sustaining

needs require special laws

technologies are often left in

to keep the cost of care

limbo, often housed

controlled and maintain

unnecessarily in institutional

the stability of their home

settings. Centralizing a federal

health care.

Current Waiver Status

19 states operate MFTD waivers

(medically fragile and technology
dependent). In 2013,
approximately $219 million state
and federal dollars accounted into
the 1915(c) waiver budget for the
care of these children.

Special Laws for Special

In federal fiscal year (FY) 2013, total state and
federal expenditures for Section 1915(c)
waivers totaled $41.4 billion. There was a 13.6%
in expenditure growth of the medically fragile
population from FY 2008 2013.
Source: Eiken, et al, 2015.

Needs is about saving

federal and state
dollars for the most
specialized care, for
children with multiple
disabilities and medical
complexities, that
require a level of care
that would be that of a
hospital level.

References:
Eiken, S., et al. 2015. Medicaid Expenditures for Section 1915(c) Waiver Programs in FY 2013. Truven
Health Analytics. Retrieved on July 2, 2016 at https://www.medicaid.gov/medicaid-chip-programinformation/by-topics/long-term-services-and-supports/long-term-services-and-supports.html
Mentro, A. 2003. Health care policy for medically fragile children. Journal of Pediatric Nursing. Vol. 18 (4):
225-232.
Nagle, V. 2014. Medicaid Waivers. Retrieved on May 17, 2016 at http://medicaidwaiver.org/.