1115 Waiver Kick-Off Meeting October 18, 2013 Office of the Governor, State of Illinois 1

Waiver Background Section 1115 waivers allow states to test new approaches in Medicaid that differ from federal program rules. Waivers are generally approved for 5 years and must result in federal expenditures that are less than or equal to what would have been spent in the absence of the waiver. In recent years, states have used waivers to: Support safety-net delivery system improvements Expand managed care, especially for high-cost populations Expand eligibility early for individuals who will become Medicaid eligible in 2014 (County Care) 2

Waiver Background Key Characteristics of 1115 Waivers – Budget Neutrality Can utilize accumulated savings to achieve budget neutrality requirements Neutrality is over life of the waiver. States can receive advance federal funding to implement innovations that will create savings in the out years. – Spending Flexibility Allows states to identify Costs Not Otherwise Matchable and build them into the Medicaid program to achieve programmatic and budgetary objectives Can receive advance federal funding to implement innovations that will create savings. 3

1115 Waiver Guiding Principles Develop an integrated, efficient delivery system Consistent with CMMI Alliance for Health principles and State Health Care Innovation Plan Includes and builds on managed care (MCO/MCCN), ACE, CCE commitments Consistent with Health Homes initiative Aligns funding and reimbursement with delivery system needs 4

1115 Waiver Guiding Principles Utilize innovative strategies not traditionally covered under Medicaid Seek flexibility to provide non-traditional supports that reduce costs and improve quality Identify potential for Medicaid funding support for infrastructure Incorporate population and community health 5

1115 Waiver Guiding Principles Strengthen home and community based services to reduce need for institutional care Seeks to break down silos to better serve consumers that have complex needs Expand opportunities for consumers to choose services that best meet their needs to maximize potential for independent living Consistent with Balancing Incentives Program (BIP), Money Follows the Person, Consent Decrees 6

1115 Waiver Guiding Principles Global waiver for all Medicaid services, populations and geographies Will incorporate all existing Medicaid 1915 waivers Includes managed care expansion and associated savings Seeks to bend cost curve to enhance services without expenditure of additional state funds 7

Waiver Process Primary Waiver Components – Existing Waiver Consolidation – Health System Transformation – Finance Working Groups Stakeholder Engagement 8

Waiver Timeline October 18, 2013Stakeholder kick-off meeting November 5, 2013Concept paper finalized December 13, 2013First draft of waiver proposal Oct. 18-Dec. 13, 2013Stakeholder meetings January 5, 2014Draft waiver posted for comment January 15, 2014Final waiver w/comments posted February 15, 2014Waiver submitted to CMS 9