Glossary

is a dollar amount established to cover the cost of all healthcare services delivered per person during a specified period of time. This term may refer to either the amount paid to a managed care organization by its private and public sector clients or a negotiated per capita rate to be paid periodically to a healthcare provider by a managed care organization. ¹⁰

refers to a model of delivering and financing healthcare services in which behavioral health services are provided under the same delivery system as physical healthcare. ¹¹

refers to the practice of having a specific benefit, such as mental health or substance abuse, operated as a distinct program, separate from the general health program. ¹²

is a range of services provided to assist and support individuals in developing their skills to gain access to needed medical, behavioral health, housing, employment, social, educational and other services essential to meeting basic human needs; linkages and training for the person served in the use of basic community resources; and monitoring of overall service delivery. This service is generally provided by nurses and other caregivers whose primary function is case management. ¹³

(CBHSQ) is within the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Administration. CBHSQ is responsible for the data collection, analysis and dissemination of behavioral health data.

(CMS) is an agency within the U.S. Department of Health and Human Services that oversees Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), health insurance portability standards and quality standards in long-term care facilities (i.e., nursing homes).

is part of the Substance Abuse and Mental Health Services Administration within the U.S. Department of Health and Human Services. CMHS works with state and local behavioral health authorities, service providers, consumers and their families to improve and increase the quality and range of mental health-related prevention, treatment, recovery, and support services.

is a workforce assessment process that fosters the growth of a qualified, ethical and culturally diverse workforce through test-based certification and/or a licensing program and the enforcement of a code of ethics.

is a concept of treatment that focuses on the services offered to an individual through a system of community support. Individuals with mental illness can remain citizens of their community if given support and access to mainstream resources such as housing and vocational opportunities. ¹⁴

is the system intended to provide public mental health services directly to those in need of assistance in the communities where they reside. Development of the community mental health system can be traced to enactment of the Community Mental Health Centers Act of 1964. Intended to provide a community-based alternative to institutional care for many people with mental illness, implementation of the community mental health system rested on the expansion of outpatient services in the community, particularly in federally funded community mental health centers (CMHCs). In many jurisdictions, the community mental health system has yet to meet the expectations of its designers or those who work within it, primarily because funding did not materialize to provide needed services. ¹⁵

is the term most frequently applied to a person who receives behavioral health services. The term is sometimes used more generically to refer to anyone who has a diagnosis of mental illness or substance abuse disorder. Not all persons with a behavioral health condition embrace this terminology, however. Some may prefer to be known simply as clients of the facilities where they receive services. People who feel they have been abused by the system or who reject traditional behavioral health services may prefer a term such as "survivor." The term "person in recovery" is often used to describe individuals who are overcoming addiction. Young people receiving behavioral health services are often simply referred to as "youth." The preference of the individual should be respected with regard to the terminology used. ¹⁶

are peer-to-peer services that are administratively controlled and operated by consumers and that emphasize self-help as their operational approach.

describes the entire service array including institutional and community mental health services, social supports groups and volunteer services that can be customized to meet a consumer's needs.

refers to two or more disorders occurring simultaneously. Generally refers to mental health and substance abuse disorders but can refer to mental health, physical health, developmental, or other disorders; also referred to as dual diagnosis or comorbid conditions. ¹⁷

is a set of steps to control or reduce inefficiencies in the consumption, allocation, or production of heath care services that contribute to unnecessary costs. Inefficiencies in consumption can occur when health services are inappropriately utilized; inefficiencies in allocation exist when health services could be delivered in less costly settings without loss of quality; and inefficiencies in production exist when the cost of producing health services could be reduced by using a different combination of resources. ¹⁸

(CIT) is a law enforcement agency program developed in Memphis, Tennessee. A CIT is comprised of designated officers who are called upon to respond to mental disturbance calls and crises, such as suicide attempts. The officers participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. Officers trained under this program are skilled in de-escalating potentially volatile situations, gathering relevant history, and assessing medication information and the individual's social support system. The CIT is recognized as a national program and has been replicated in communities such as Portland, Oregon; Albuquerque, New Mexico; Seattle, Washington; City of Frisco, Texas; Durham, North Carolina; San Jose, California; and Waterloo, Iowa. ¹⁹

in the context of addressing the needs of persons with both mental health problems and justice system involvement is the implementation of a training program to educate individuals from both the criminal justice and the mental health communities on the issues and concerns each confronts. Cross-training attempts to build awareness in both communities to help develop a more coordinated approach to the needs of people with mental illness involved with the criminal justice system. ²⁰

is a set of congruent behaviors, attitudes and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. The Office of Minority Health in the U.S. Department of Health and Human Services produced a set of guidelines for national standards for healthcare organizations for the provision of culturally & linguistically appropriate services (CLAS Standards). ²¹

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is a temporary return to a lower level of psychological adaptation or functioning, often occurring when an individual is under considerable stress. ²²

are the range of personal, social and economic factors which determine the health and mental health status of individuals or populations. ²³

is a substantial impairment in mental or physical functioning, with onset before the age of 22 and of indefinite duration. Examples include autism, cerebral palsy, uncontrolled epilepsy, certain other neuropathies and Down syndrome. ²⁴

is the standard reference handbook used by behavioral health professionals in the United States to classify mental health conditions. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). The American Psychiatric Association published the first manual in 1952, with the most recent edition (DSM V) published in 2013. ²⁵

is a written plan that provides guidance to help him/her make a successful transition from an institution to the community. Typically includes concrete plans in several areas such as housing, employment or education, transportation, continued counseling or social services, required supervision (i.e., probation/parole when leaving a correctional setting), and the like. General hospitals also provide discharge plans for patients that could include among several items, medication instructions and dietary restrictions. ²⁶

is reimbursement made by a state's Medicaid program to hospitals that the state designates as serving a "disproportionate share" of low income or uninsured patients. These payments are in addition to the regular payments such hospitals receive for providing inpatient care to Medicaid beneficiaries. ²⁷

(related to the justice system): A dispositional practice is considered diversion if: (1) it offers persons charged with criminal offenses alternatives to traditional criminal justice or juvenile justice proceedings; (2) it permits participation by the accused only on a voluntary basis; (3) it occurs no sooner than the filing of formal charges and no later than a final adjudication of guilt; and (4) it results in a dismissal of charges, or its equivalent, if the divertee successfully completes the diversion process. ²⁸

is a treatment program that addresses the specific needs of a person with mental illness who has been "diverted" from the criminal justice system either before arrest or before trial. ²⁹

is a peer-run program model of peer services that are housed at a central location and focus on social skills development and support within an informal setting.

is a listing of medications that consumers may readily access through their health plans. Non-formulary medications may not be accessible or may be accessible only if prior authorization is obtained. Often, the medications on the formulary tend to be the cheapest, rather than the most effective. ³⁰

is a term used to describe an individual who is eligible both for Medicare and for full Medicaid coverage, including nursing home services and prescription drugs as well as payments of Medicare premiums. Some Medicare beneficiaries are eligible for Medicaid payments for some or all of the Medicare premiums, deductibles and co-insurance requirements, but not for Medicaid nursing home or prescription drug benefits. ³¹

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is one of the services that states are required to include in their basic packages for all Medicaid-eligible children under age 21. EPSDT services include periodic screening to identify physical and mental conditions as well as vision, hearing and dental problems. EPSDT services also include follow-up diagnostic and treatment services to correct conditions identified during a screening, without regard to whether the state Medicaid plans covers those services with respect to adult beneficiaries.

are digital health records that contain a patient’s medical and treatment histories that can be available instantly and securely to authorized users such as specialists, pharmacies, and emergency departments.

is a statute which governs when and how a patient may be (1) refused treatment or (2) transferred from one hospital to another when the patient is in an unstable medical condition. EMTALA was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), and it is sometimes referred to as "the COBRA law." ³³

is a group of federal statutes enacted in 1974 that, among other things, prohibits states from regulating the employee welfare benefit plans, including health plans, of self-insured businesses. ERISA does, however, establish certain regulations related to reporting and disclosure, fiduciary standards, claims review and enforcement. It also provides limited protection against discrimination to ERISA health plan participants. ³⁴

occurs when a person gains rights and authority in addition to feeling a sense of personal independence and competence for their clinical condition.

are benefits provided by the federal government for individuals with disabilities (disability is defined as "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months"). Entitlements available to people with mental illness include income support through the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs, and health insurance coverage under Medicaid and Medicare. ³⁵

is the study of the distribution and determinates of health-states or events in specified populations, and the application of this study to the control of health problems. ³⁶

is a regulation under the Affordable Care Act ensuring that health insurance plans offer a comprehensive package of healthcare services within the following categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services (including behavioral health services); laboratory services; preventative and wellness services and chronic disease management; and pediatric services. ³⁷

is a face-to-face interview with an individual and a review of all reasonably available healthcare records and collateral information. Evaluation includes a diagnostic formulation and, at minimum, an initial treatment plan.

are approaches to prevention or interventions for which there is consistent scientific evidence showing that they improve client outcomes.

 

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consists of activities to provide information and education to families and significant others regarding mental disorders and their treatment. This activity acknowledges the importance of involving significant others who may be essential in assisting a client to maintain treatment and to recover. Family psycho-education models include courses taught by mental health professionals as well as those taught by family members themselves. ³⁹

provide primary care services to medically underserved areas and populations. FQHCs are federally funded centers that provide services on a sliding scale fee to consumers.

is a traditional method of paying for medical services under which providers are paid for each office visit, treatment, procedure, or other service rendered. See capitation. ⁴⁰

are tools to assess the adequacy of implementation of program models. Specifically, fidelity measures quantify the degree to which the elements in a program model have been adequately implemented.

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is the use of computer hardware, software or infrastructure to record, store, protect and retrieve clinical, administrative, or financial information. HIT includes electronic health records, personal health records, and electronic medical records.

is legislation intended to provide portability of employer-sponsored insurance from one job to another in order to prevent what has become known as "job lock" or the inability to change jobs because of the fear of losing health insurance. This act also makes it illegal to exclude people from coverage because of preexisting conditions and offers some tax deductions to self-employed people who pay their own health insurance premiums. The act also directs the federal government to standardize billing codes and to develop privacy standards related to individually identifiable healthcare information. ⁴¹

is a form of managed care. All health services are delivered and paid for through one organization, often under one roof. An HMO requires its participants to use only certain health providers and hospitals, usually those within its own network.

is a subsidized health insurance pool organized by some states as an alternative for individuals who have been denied health insurance because of a medical condition, or whose premiums are rated significantly higher than the average due to their health status or claims experience. HIPPA allows states to use high-risk pools as an "acceptable alternative mechanism" that satisfied the statutory requirement for ensuring access to health insurance coverage for certain individuals. ⁴²

refer to any care or services provided at a person's residence or in a noninstitutional setting located in the community. HCBS may include home health care, adult day care or treatment, medical services, respite services or other interventions provided with the goal of the person receiving care at home or in their community to avoid institutionalization. Section 2176 of the Omnibus Reconciliation Act allows states to offer these services under a waiver. ⁴³

now known as the Housing Choice Voucher program (HCV), is a tenant-based program which assists low-income families, older persons, and people with disabilities to rent decent, safe and sanitary housing in the community. ⁴⁴

is a federal grant program authorized under the McKinney/Vento Homeless Assistance Act. Through the Section 8 Mod Rehab SRO program, a Public Housing Agency (PHA) makes rental assistance payments to landlords on behalf of a person who is homeless and rents the rehabilitated unit. ⁴⁵

insures mortgage loans which facilitate the construction and substantial rehabilitation, acquisition or refinancing of nursing homes, intermediate care facilities, board and care homes, and assisted-living facilities. ⁴⁶

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is a growing trend within the behavioral health field in which clients educate themselves to recognize symptoms of their illness as well as factors that exacerbate or ameliorate them. By managing those factors and taking remedial steps when symptoms become acute, some find they are able to avoid more intrusive interventions by professionals. Individuals who are successful in managing their illness gain confidence in their ability to achieve recovery. ⁴⁷

is any medical facility - usually a hospital - where patients stay for a period of time to receive treatment. Most behavioral health systems differentiate between acute care (short-term) facilities and long-term care facilities. ⁴⁸

provides states/territories with funding as well as mandates to provide a free and appropriate education and procedural safeguards for all children ages 3 through 21 with disabilities without regard to costs incurred by states and localities. ⁴⁹

is an agreement between participating states, which work together to ensure the transfer of a person with a behavioral health condition or developmental disability from a public institution in one state to another state. The transfer is based on clinical determination that the person's treatment and situation (i.e., the person has close and involved family, friends and/or guardian in the compact state and the transfer would be in the best interest of the person). ⁵⁰

is a facility of more than 17 beds that is primarily engaged in providing treatment services for individuals diagnosed with behavioral health conditions. The Federal Medicaid program does not provide for payment of services for any individual who is age 21-64 who is a patient in an IMD (42 CFR 440.1008).

generally refer to providing an array of services through a single agency or entity. Often requires discretionary or blended funding to cover the cost of multiple services. A term most frequently used in the behavioral health field when referring to services for co-occurring disorders mental illness and substance abuse disorders, or linkages between primary care and behavioral healthcare services. ⁵¹

is a public or private facility, the primary purpose of which is to provide health or rehabilitative services to individuals with developmental disabilities or related conditions (e.g., cerebral palsy). State Medicaid agencies have the option to cover services provided by ICFs/MR. ⁵²

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describes a set of tools that are designed to control healthcare cost primarily by sharing patient costs across large group of individuals. ⁵³

is an entity that is contracted to coordinate healthcare service delivery in a cost-effective manner. MCOs are often paid a set fee to care for populations of individuals over a set period of time. ⁵⁴

is a computer network for storing, accessing, and managing data in electronic form, and also the database of that information.

is a nationwide health insurance program for low-income and disabled people who meet needs-based eligibility requirements. Currently Medicaid covers approximately 53 million individuals including children, the aged, the blind, and/or disabled and people who are eligible to receive federally assisted income maintenance payments. It is jointly financed and administered under the Centers for Medicare and Medicaid and state Medicaid agencies. ⁵⁵

allow states to provide a range of home and community-based services for people who would otherwise be in Medicaid covered institutions (children under the age of 22 or adults over the age of 64); also known as 1915(c) waivers. ⁵⁶

is a model that allows for certain services that support recovery to be billed and reimbursed through the Centers for Medicaid and Medicare Services.

refers to the determination that services or supplies are appropriate and consistent with the diagnosis in accord with accepted standards of community practice and are not considered experimental. They also cannot be omitted without adversely affecting the individuals' condition or the quality of medical care. ⁵⁷

is a federal health insurance program primarily for Americans 65 and older, younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). ⁵⁸

is a policy that pays coinsurance, deductibles and copayments for Medicare recipients. It also guarantees additional coverage for services up to a predefined benefit limit (the portion of the cost of services not covered by Medicare). ⁵⁹

is the capacity of an individual to function effectively in society. It is influenced by biological, environmental, emotional, and cultural factors and is highly variable in definition, depending on time and place. ⁶⁰ Mental health is not just the absence of a mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. ⁶¹

is a term used by mental health professionals referring to a person with whom they have a clinical relationship.

is a term referring to a person who is receiving mental health services.

is a federal law that requires health insurance plans to cover both mental and physical health equally. Under the law, individuals seeking treatment for mental health and substance use disorders must receive the same coverage comparable to other medical conditions. The law prohibits insurance companies to limit hospital stay, outpatient treatment sessions, or assign higher co-payments for mental health or substance use treatment unless those limitations are also imposed on medical/surgical benefits; also referenced as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). ⁶²

as characterized by the Institute of Medicine, refers to "efforts to enhance individuals' ability to achieve developmentally appropriate tasks (competence) and a positive sense of self-esteem, mastery, well-being, and social inclusion and to strengthen their ability to cope with adversity." ⁶³

efforts are distinguished from strategies to prevent mental/emotional/behavioral disorders depending upon the stated goals of the intervention (e.g., optimizing health and wellbeing versus reducing illness or problems), and therefore the outcome measurements that are incorporated into the endeavor. ⁶⁴

is a term that is used by some to refer to a person who has survived the mental health system and/or mental illness.

is a term that refers to a health condition that is characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.

are composed of mental health service professionals who provide on-scene responses in mental health emergencies.

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is the national organization that represents the policy and program interests of state departments of mental health. NASMHPD conducts research, sponsors special conferences and meetings, and disseminates reports on behavioral healthcare issues.

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is any treatment that takes place on an ambulatory (as opposed to inpatient or residential) basis. ⁶⁷

 

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is a generic reference to any service that is provided by a consumer.

are a collection of services designed to improve service recipient outcomes.

refers to the primary prevention of the initial onset of a disorder. The Institute of Medicine has established a classification of primary prevention activities based upon the risk level of the population being targeted: (1)

prevention practices are targeted to a general population, without regard to the risk levels of the individuals included;

prevention interventions are those that are provided to a particular group because one or more factors increase the vulnerability of those individuals to certain negative outcomes; and

prevention efforts are those that are targeted to persons exhibiting problems, but not yet reaching the diagnostic level of a disorder, or those with certain biological predispositions. Within this framework, the emphasis is on reducing/mitigating malleable risk factors associated with the development of mental and emotional problems, and enhancing malleable protective factors that foster healthy functioning and resilience.

is a program authorized by the Stewart B. McKinney Homeless Assistance Amendments Act of 1990. The formula grant program is administered by CMHS that assist over 480 organizations to address the multiple needs of individuals who are homeless and have a mental illness. ⁶⁹

is a formula grant program administered by the Federal Center for Mental Health Services which supports Protection and Advocacy (P&A) systems designated by the Governor of each state, the District of Columbia, territories and the American Indian Consortium to protect and advocate for the rights of individuals with disabilities. ⁷⁰

is professional behavioral health services that bring together approaches from the rehabilitation and the behavioral health fields. These services combine pharmacological treatment, skills training, and psychological and social support to clients and families in order to improve their lives and functional capacities. ⁷¹

are prescription drugs that address psychiatric symptoms, usually given to reduce anxiety, depression, or other consequences of mental illness such as hallucinations, delusions, or bizarre thinking. ⁷²

is the science and art of improving health, prolonging life, and improving the quality of life among whole populations through health promotion, disease prevention, and other forms of health intervention. ⁷³

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is a public program that pays the premiums, deductibles and coinsurance for individuals who are on Medicare and at or below the federal poverty level. ⁷⁴

is a formal methodology designed to assess the quality of services provided. Quality assurance includes formal review of care, problem identification, corrective actions to remedy any deficiencies and evaluation of actions taken.

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is a value that reinforces the concept of mental illness as a temporary condition. SAMHSA defines it as a "process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential." ⁷⁵

refers to the capacity to maintain a relatively stable equilibrium and healthy levels of psychological and physical functioning--despite exposure to adversity--through positive adaptation. It is not an inherent trait, but rather a dynamic process that can vary across time and life domains. ⁷⁶

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are a class of antidepressants that primarily blocks the action of the transporter protein for a neurotransmitter, serotonin, thus leaving more serotonin to remain at the synapse (a structure that permits a neuron to pass an electrical or chemical signal to another human cell). These medications appear to be effective because serotonin is directly involved in the body's ability to regulate moods. Examples of these medications include such brands as Prozac, Paxil, Celexa, and Zoloft. ⁷⁷

refers to a movement within the behavioral health field in which clients develop and provide behavioral health services to other clients to promote recovery. ⁷⁸

is a term defined by federal regulations that generally applies to mental disorders that interfere with some area of social functioning. This term is used to describe adults over the age of 18. ⁷⁹

is a term used in various federal statutes in reference to children under the age of 18 with a diagnosable mental health problem that severely disrupts their ability to function socially, academically and emotionally. ⁸⁰

describes studies of places or groups, like a community mental health center, that offer services to people. The research usually focuses on effectiveness of services.

is a term that incorporates the concepts of chronicity or recurrence with the definition of

below, often used to describe clients with a high level of need. ⁸¹

is a term that applies to more seriously affected individuals. This category includes schizophrenia, bipolar disorder, and other severe forms of depression, panic disorder and obsessive-compulsive disorder. ⁸²

is for individuals who worked and are "insured" by the Social Security taxes (F.I.C.A.) that are withheld from their earnings to replace part of a person's earnings upon retirement, disability, or for survivors when a worker dies. If insured workers (and, in some cases, their dependents or survivors) become disabled, they may become eligible for SSDI benefits. The amount received is dependent upon how many years an individual has worked and the individual must apply to determine if (s)he is eligible for benefits. See also entitlements. ⁸³

is a public program that pays a portion of Medicare premiums for those whose incomes are slightly above the Federal poverty level. ⁸⁴

provides funds to states to initiate and expand child health insurance for uninsured, low-income children whose family income exceeds Medicaid eligibility levels. ⁸⁵

is a federal income supplement program funded by general tax revenues. It provides cash to meet basic needs for food, clothing and shelter for older persons and persons with disabilities who have little or no income. ⁸⁶

is an operating division within the U.S. Department of Health and Human Services which was established in 1992 to support the provision of effective prevention, treatment, and recovery services for persons with or at risk for mental illness and substance use disorders. To accomplish its work, SAMHSA administers a combination of competitive, formula, and block grant programs and data collection activities.

is a term that encompasses suicidal thoughts, ideation, plans, suicide attempts, and completed suicide. ⁸⁷

are rehabilitative services that are not strictly medical but are nonetheless considered to be necessary to the recovery process for many clients. Such services are designed to develop and/or restore a person's functional capacities and may include support to enable clients to maintain independent housing, education, employment, transportation or other activities associated with community integration.

is an evidence-based service that matches and trains persons with severe developmental, mental, or physical disabilities to jobs where their specific skills and abilities make them valuable assets to employers; also known as supported employment. ⁸⁸

is a system of professional and/or peer supports that allows a person with mental illness to live independently in the community. Such supports may include regular staff contact and assistance as needed with household chores, as well as the availability of crisis services or other services designed to prevent relapse, such as mental health, substance abuse, and employment; also known as supported housing. ⁸⁹

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is a term to describe manuals, instructions, consultations, etc. that give information or support for learning a technical task or skill.

is the use of telecommunications and information technologies by mental health clinicians to provide care at a distance. A qualified mental health professional is able to interview and examine a client who may not be able to access services in rural or frontier communities. ⁹⁰

provides assistance and work opportunities to needy families, including persons with mental illnesses by granting states the federal funds and wide flexibility to develop and implement their own welfare programs. ⁹¹

is a key component of psychosocial rehabilitation in which consumers set their own vocational goals, which form the basis for motivation toward recovery of vocational roles. ⁹²

is a voluntary program which provides improved access to employment training and placement services for people with disabilities who want to work. TWWIIA is administered by the Social Security Administration (SSA). ⁹³

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is the principle governing agency for protecting the health and well-being of Americans by providing essential human services including research, public health, food and drug safety, grants and funding to states and local governments, and other services.

 

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is a term that covers a wide range of services designed to assist individuals with disabilities in regaining skills needed to function in the workplace. It is generally delivered under the auspices of a state department of vocational rehabilitation and supported by state and federal appropriations. Eligibility for VR programs is established under the federal Rehabilitation Act. Programs offered by state VR agencies may include supported employment, Ticket to Work, Pathways to Independence, and work-readiness programs. ⁹⁴

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are various authorities under which the Secretary of the U.S. Department of Health and Human Services (HHS) may, upon the request of a state, allow the state to receive federal Medicaid matching funds for its expenditures even though it is no longer in compliance with certain requirements or limitations of federal Medicaid statute. Waivers provide states an avenue to test new or current demonstrations to delivery and pay for healthcare services. There are four primary types of waivers and demonstration projects, including 1115 research and demonstration projects, 1915(b) managed care waivers, 1915(c) home and community-based services waivers, and concurrent 1915(b) and (c) waivers. ⁹⁵