Federal health care waivers

The Substance Use Disorder (SUD) waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) on Aug. 16, 2019, and is effective from July 1, 2019, through June 30, 2024. The SUD waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.

DHS submitted an extension request to CMS on Dec. 21, 2023, to continue the waiver for a five-year period beginning July 1, 2024. The CMS review and determination process could take several months. 

This demonstration project is an important component of the state’s larger reform effort to address the opioid crisis as well as transform the health care delivery system for Medicaid members who need substance use disorder treatment. The waiver authorizes federal Medicaid matching funds for residential programs that have been determined as Institutions for Mental Diseases. The demonstration waiver tests the impact of evidence-based provider referral arrangements and practices on improving health outcomes for Medicaid members with substance use conditions.

SUD Waiver Documents and Reports

Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and are specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.

• SUD waiver approval, expenditure and waiver authorities, and special terms and conditions (PDF)
• SUD Waiver Monitoring Protocol Part A (XLSX)
• SUD Waiver Monitoring Protocol Part B (PDF)
• SUD Waiver Extension Request (PDF) (submitted to CMS on Dec. 21, 2023)
• SUD Waiver Extension Request Summary (PDF) (submitted to CMS on Dec. 21, 2023)

Design Plans and Evaluation Reports

• SUD Waiver Implementation Plan (PDF)
• SUD Waiver Evaluation Design Plan (PDF)
• SUD Waiver Mid-Point Assessment, Demonstration Year 2, March 2022 (PDF) (CMS-approved document with updates for accessibility) 
• SUD Waiver Draft Interim Evaluation Report, July 2023 (PDF) (submitted to CMS on Dec. 21, 2023, with the waiver extension request)

Quarterly and Annual Reports

DHS posts reports as they are approved by CMS.

SUD Demonstration Year 1 (July 1, 2019-June 30, 2020) 

• Quarterly Reports for Demonstration Year 1, Quarters 2 and 3 (PDF)
• Annual Report for Demonstration Year 1 (PDF)

SUD Demonstration Year 2 (July 1, 2020-June 30, 2021)

• Quarterly Report for Demonstration Year 2, Quarter 1 (PDF)
• Quarterly Report for Demonstration Year 2, Quarter 2 (PDF)
• Quarterly Report for Demonstration Year 2, Quarter 3 (PDF)
• Quarterly Report for Demonstration Year 2, Quarter 4 (PDF)

SUD Demonstration Year 3 (July 1, 2021 - June 30, 2022)

• Quarterly Report for Demonstration Year 3, Quarter 1 (PDF)
• Quarterly Report for Demonstration Year 3, Quarter 2 (PDF) from the U.S. government’s Medicaid website
• Quarterly Report for Demonstration Year 3, Quarter 3 (PDF) from the U.S. government’s Medicaid website 
• Annual Report for Demonstration Year 3 (PDF) from the U.S. government’s Medicaid website 

SUD Demonstration Year 4 (July 1, 2022 - June 30, 2023)

• Quarterly Report for Demonstration Year 4, Quarter 1 (PDF) from the U.S. government’s Medicaid website 
• Quarterly Report for Demonstration Year 4, Quarter 2 (PDF) from the U.S. government’s Medicaid website 
• Quarterly Report for Demonstration Year 4, Quarter 3 (PDF) from the U.S. government’s Medicaid website 

The Prepaid Medical Assistance Project Plus (PMAP+) waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) in July 1995. The PMAP+ waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.

On Nov. 15, 2023, CMS approved Minnesota’s request to extend the waiver from Jan. 1, 2024, through Dec. 31, 2028. 

The PMAP+ waiver provides federal authority to: 

• Cover children under Medical Assistance who are 12 to 23 months old with income eligibility above 275% and at or below 283% of the federal poverty level (FPL).
• Waive the federal requirement to redetermine the basis of Medical Assistance eligibility for caretaker adults with incomes at or below 133% of the FPL who live with children age 18 who are not full-time secondary school students.
• Provide Medical Assistance benefits to pregnant people during the period of presumptive eligibility.

PMAP+ Waiver Documents and Reports

Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and are specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.

• PMAP+ waiver approval, expenditure and waiver authorities, and special terms and conditions (PDF) from the U.S. government’s Medicaid website
• PMAP+ waiver approved extension request (PDF) from the U.S. government’s Medicaid website

DHS submitted the following PMAP+ amendments to CMS on Jan. 25, 2024. The CMS review and determination process could take several months.

• Amendment for extended and expanded continuous Medicaid eligibility for children and young people through age 20 (PDF)
• Amendment to provide Medicaid coverage for former foster care youth up to age 26 (PDF)

Design Plans and Evaluation Reports

• Refer to Attachment C, PMAP+ Waiver Evaluation Plan for 2021-2025, of the Minnesota PMAP+ Section 1115 Waiver Extension Request (PDF) from the U.S. government’s Medicaid website
• Refer to Attachment B, PMAP+ Waiver Interim Evaluation Report 2014-2018, of the Minnesota PMAP+ Section 1115 Waiver Extension Request (PDF) from the U.S. government’s Medicaid website
• PMAP+ Waiver Final Summative Evaluation Report (Revised report is expected to be completed in June 2025)
• PMAP+ Waiver Reasonable Opportunity Period (ROP) Evaluation Design (PDF) from the U.S. government’s Medicaid website

Quarterly and Annual Reports

DHS posts reports as they are approved by CMS. DHS archives reports from prior demonstration years. Email dhspfr.federalrelations@state.mn.us to request an archived report.

PMAP+ Demonstration Year 24 (July 1, 2018 - June 30, 2019)

• Quarterly reports for Demonstration Year 24 (PDF)
• Annual report for Demonstration Year 24 (PDF)

PMAP+ Demonstration Year 25 (July 1, 2019 - June 30, 2020)

• Quarterly report 1 for Demonstration Year 25 (PDF)
• Quarterly report 2 for Demonstration Year 25 (PDF)
• Quarterly report 3 for Demonstration Year 25 (PDF)
• Quarterly report 4 for Demonstration Year 25 (PDF)
• Annual report for Demonstration Year 25 (PDF)

PMAP+ Demonstration Year 26 (July 1, 2020 - June 30, 2021)

• Quarterly report 1 Demonstration Year 26 (PDF)
• Quarterly report 2 Demonstration Year 26 (PDF)
• Quarterly report 3 Demonstration Year 26 (PDF)
• Quarterly report 4 Demonstration Year 26 (PDF)
• Annual report for Demonstration Year 26 (PDF)

PMAP+ Demonstration Year 27 (July 1, 2021 – June 30, 2022)

• Quarterly report 1 Demonstration Year 27 (PDF)
• Quarterly report 2 Demonstration Year 27 (PDF)
• Quarterly report 3 Demonstration Year 27 (PDF) 
• Quarterly report 4 Demonstration Year 27 (PDF)
• Annual report for Demonstration Year 27 (PDF)

PMAP+ Demonstration Year 28 (July 1, 2022 – June 30, 2023)

• Quarterly report 1 Demonstration Year 28 (PDF)
• Quarterly report 2 Demonstration Year 28 (PDF)
• Quarterly report 3 Demonstration Year 28 (PDF)
• Quarterly report 4 Demonstration Year 28 (PDF)
• Annual report for Demonstration Year 28 (PDF) from the U.S. government’s Medicaid website

The Reform 2020 waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) on Oct. 18, 2013. The Reform 2020 waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.

On Jan. 31, 2020, CMS approved Minnesota’s request to extend the Reform 2020 waiver through Jan. 31, 2025. DHS will submit an extension request to CMS to continue the waiver for a five-year period beginning Jan. 31, 2025. You will be able to review and comment on the draft extension request when it’s posted under the Public Hearings and Comments section. This is expected to be in the summer, 2024.

The Reform 2020 waiver provides federal financial support for the Alternative Care program. This program provides home and community-based support to help older adults with lower income, who are at risk of nursing home placement, stay in their homes.

Reform 2020 Waiver Documents and Reports

Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.

• Reform 2020 waiver approval, expenditure and waiver authorities, and special terms and conditions (PDF)
• Reform 2020 waiver approved extension request (PDF) from the U.S. government’s Medicaid website

Design Plans and Evaluation Reports

• Reform 2020 Waiver Evaluation Design Plan (PDF)
• Reform 2020 Waiver Draft Interim Evaluation Report (Revised report is expected to be completed in June 2024)

Quarterly and Annual Reports

DHS posts reports as they are approved by CMS. DHS archives reports from prior demonstration years. Email dhspfr.federalrelations@state.mn.us to request an archived report.

Reform 2020 Demonstration Year 7 (July 1, 2019 - June 30, 2020)

• Quarterly report 1 Demonstration Year 7 (PDF)
• Quarterly report 2 for Demonstration Year 7 (PDF)
• Quarterly report 3 Demonstration Year 7 (PDF)
• Quarterly report 4 Demonstration Year 7 (PDF)
• Annual Report Demonstration Year 7 (PDF)

Reform 2020 Demonstration Year 8 (July 1, 2020 - June 30, 2021)

• Quarterly report 1 Demonstration Year 8 (PDF)
• Quarterly report 2 Demonstration Year 8 (PDF)
• Quarterly report 3 Demonstration Year 8 (PDF)
• Annual and Quarterly Report 4 Demonstration Year 8 (PDF)

Reform 2020 Demonstration Year 9 (July 1, 2021 – June 30, 2022)

• Quarterly report 1 Demonstration Year 9 (PDF)
• Quarterly report 2 Demonstration Year 9 (PDF)
• Quarterly report 3 Demonstration Year 9 (PDF) 
• Annual and Quarterly report 4 Demonstration Year 9 (PDF)

Reform 2020 Demonstration Year 10 (July 1, 2022 – June 30, 2023)

• Quarterly report 1 Demonstration Year 10 (PDF)
• Quarterly report 2 Demonstration Year 10 (PDF)
• Quarterly report 3 Demonstration Year 10 (PDF)
• Annual and Quarterly report 4 Demonstration Year 10 (PDF)

Reform 2020 Demonstration Year 11 (July 1, 2023 – June 30, 2024)

• Quarterly report 1 Demonstration Year 11 (PDF)
• Quarterly report 2 Demonstration Year 11 (PDF)

Waiver background

The 2016 Minnesota State Legislature directed DHS to seek federal waiver authority to allow tribal organizations to receive the Indian Health Services encounter rate for Medicaid services provided to American Indian and Alaskan Native populations. Only organizations that are dually certified as Urban Indian Health Programs and Federally Qualified Health organizations qualify. The Legislature also asked DHS to seek authority for the state to be eligible for 100% federal financial participation for such services. Refer to Minnesota Statutes, 256B.0625, subdivisions 30 and 34.

DHS submitted the Indian Health Board (IHB) of Minneapolis Section 1115 waiver request to CMS on Jan. 13, 2017. Currently, the IHB is the only entity eligible under this waiver authority, should it be granted by CMS. As a demonstration project under section 1115 of the Social Security Act, DHS plans to test new ways to help urban American Indians served by the IHB to access quality health care. This approach includes the use of an abbreviated application process for American Indians eligible for Medicaid and targeting additional funding for the IHB into enhanced care coordination and application assistance for this population.

The IHB waiver application was initially submitted to CMS on Jan. 13, 2017. A 30-day comment period on the initial IHB waiver application was held before submission, beginning on Dec. 12, 2016. The initial application was revised to include information on the research hypothesis and evaluation parameters related to the demonstration’s proposed goals. A 30-day comment period on the revised waiver application began on Apr. 17, 2017. The revised application was submitted to CMS on May 17, 2017.

• Revised IHB Waiver Application (PDF)
• Attachment D: Evaluation Plan (PDF)

Information about submitting comments or requesting copies of section 1115 waiver materials

This section includes information about the public comment process, requesting documents, comment periods and public forums.

Public comment process

Public comment periods for waivers are posted in this section. DHS must receive your comments by the posted deadline.

Email comments about waiver amendments or extensions to Section1115WaiverComments@state.mn.us. DHS requests comments be submitted in Microsoft Word format or incorporated within the email text to support making comments available to people who use screen readers. If you would also like to provide a signed copy of a comment letter, you may submit a second copy in Adobe PDF format. Comments provided on paper or in an electronic format that cannot be converted for a screen reader may be reformatted to meet state accessibility requirements for posting. The original formatting and content will be kept as much as possible. For example, if graphics or tables are included, a description that can be read will be added. Comments received may be posted publicly.

Paper copies of amendments and extensions are available by request. Email Section1115WaiverComments@state.mn.us to request a copy be mailed, or to pick up a copy. Mail your request or comments via the U.S. Postal Service to:

Minnesota Department of Human Services
Federal Relations – Medicaid Waivers
P.O. Box 64967
St. Paul, MN 55164-0967

Comment periods for waiver documents

Information about waiver documents available for review and comment is posted in this section in advance of submission to CMS. DHS receives comments through the process described under the Public comment process heading on this webpage.

No waiver documents are currently posted for public comment.

Comments for public forums

Information about participation in public forums is posted in this section in advance of the forum, and comments are taken during the forum.

No public forums are currently scheduled.

The MSC+ waiver allows Minnesota to require seniors to enroll in managed care to receive Medicaid services. This includes people who are dually eligible for both Medicaid and Medicare and who have not opted to enroll in Minnesota Senior Health Options (MSHO). The MSC+ waiver operates in combination with Minnesota’s Elderly Waiver to enable the integration of community-based long-term care services into the managed care service delivery system. The waiver also provides federal authority to require certain populations eligible for Medical Assistance to enroll in managed care, including American Indians and children who are in foster care.

The current MSC+ waiver expires June 30, 2026. Review the MSC+ Waiver and CMS Approval letter (PDF) for more information.

DHS submitted a revised waiver amendment request to the Centers for Medicare and Medicaid Services (CMS) on Nov. 30, 2023 to add Community First Services and Supports (CFSS) to MSC+. CMS approved the amendment on Feb. 27, 2024 with an effective date of June 1, 2024. DHS is submitting an amendment to CMS in June 2024 to change the effective date of CFSS from June 1, 2024 to Oct. 1, 2024. There are no additional substantive revisions to the content of the waiver request approved by CMS on Feb. 27, 2024.

Refer to the MSC+ waiver amendment (PDF) for a copy of the amendment request, and MSC+ budget neutrality spreadsheet for budget neutrality information. 

DHS invites public comment on this amendment. Comments must be received by June 12, 2024.

Public comment process

Email comments to DHS.Waiver.Comments@state.mn.us by June 12, 2024. DHS requests comments be submitted in Microsoft Word format or incorporated within the email text to support making comments available to people who use screen readers. If you would also like to provide a signed copy of a comment letter, you may submit a second copy in Adobe PDF format. Comments provided on paper or in an electronic format that cannot be converted for a screen reader may be reformatted to meet state accessibility requirements for posting. The original formatting and content will be kept as much as possible. For example, if graphics or tables are included, a description that can be read will be added. Comments received may be posted publicly.

Paper copies of the amendment are available by request. Email DHS.Waiver.Comments@state.mn.us to request a copy be mailed, or to pick up a copy. Mail your request or comments via the U.S. Postal Service to:

Minnesota Department of Human Services
Federal Relations – Medicaid Waivers
P.O. Box 64967
St. Paul, MN 55164-0967

The Case Management waiver allows Minnesota to continue to limit case management providers for the home and community-based waivers to counties and tribes under contract with DHS or their subcontractors. The waiver applies only to enrollees whose waiver services are covered under Medicaid fee-for-service and who receive services under one of the following Section 1915(c) home and community-based waiver programs:

• Developmental Disabilities Waiver (DD)
• Elderly Waiver (EW)
• Community Access for Disability Inclusion (CADI) Waiver
• Brain Injury Waiver (BI)
• Community Alternative Care (CAC)

The current Case Management waiver expires Mar. 31, 2027. Review the Case Management Waiver and CMS Approval Letter (PDF) for more information.

This is a free email subscription service that allows you to receive one-way email notification when new information is available about Medicaid waivers, such as the Reform 2020 waiver, the Prepaid Medical Assistance Plus (PMAP+) waiver, the Minnesota Senior Care Plus (MSC+) waiver and new waiver applications. Subscribers will receive emails when DHS is seeking public comment on items that will be submitted for federal approval, when requests for federal authority are submitted to the federal government, and when waiver requests have been approved or denied by CMS.

Information on Minnesota’s federal Medicaid waivers is also available on the CMS State Waivers List webpage (enter Minnesota in the search box).