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1915(b) Managed Care Waivers

1915(b) Waivers are one of several options available to states that allow the use of Managed Care external link will open in a new window in the Medicaid Program. When using 1915(b), states have four different options:

  • [1915(b)(1)] - Implement a managed care delivery system that restricts the types of providers that people can use to get Medicaid benefits
  • [1915(b)(2)] - Allow a county or local government to act as a choice counselor or enrollment broker) in order to help people pick a managed care plan
  • [1915(b)(3)] - Use the savings that the state gets from a managed care delivery system  to provide additional services
  • [1915(b)(4)] - Restrict the number or type of providers who can provide specific Medicaid services (such as disease management or transportation)
Managed CareAn organized system for delivering comprehensive mental health services that allows the managed care entity to determine what services will be provided to an individual in return for a prearranged financial payment. Generally, managed care controls health care costs and discourages unnecessary hospitalization and overuse of specialists, and the health plan operates under contract to a payer.
MedicaidMedicaid is a health insurance assistance program funded by Federal, State, and local monies. It is run by State guidelines and assists low-income persons by paying for most medical expenses.
Medicaid clientMental health clients to whom some services were reimbursable through Medicaid.
Medical Group PracticeA number of physicians working in a systematic association with the joint use of equipment and technical personnel and with centralized administration and financial organization.
Medical Review CriteriaScreening criteria used by third-party payers and review organizations as the underlying basis for reviewing the quality and appropriateness of care provided to selected cases.
Medically Necessary

Health insurers often specify that, in order to be covered, a treatment or drug must be medically necessary for the consumer. Anything that falls outside of the realm of medical necessity is usually not covered. The plan will use prior authorization and utilization management procedures to determine whether or not the term "medically necessary" is applicable.

MedicareMedicare is a Federal insurance program serving the disabled and persons over the age of 65. Most costs are paid via trust funds that beneficiaries have paid into throughout the courses of their lives; small deductibles and some co-payments are required.
Medication Therapy

Prescription, administration, assessment of drug effectiveness, and monitoring of potential side effects of psycho-tropic medications.

MemberUsed synonymously with the terms enrollee and insured. A member is any individual or dependent who is enrolled in and covered by a managed health care plan.
Mental HealthHow a person thinks, feels, and acts when faced with life's situations. Mental health is how people look at themselves, their lives, and the other people in their lives; evaluate their challenges and problems; and explores choices. This includes handling stress, relating to other people, and making decisions.
Mental Health Advance DirectiveA written document stating a consumer's instructions for mental health treatment.  
Mental Health Parity (Act)Mental health parity refers to providing the same insurance coverage for mental health treatment as that offered for medical and surgical treatments. The Mental Health Parity Act was passed in 1996 and established parity in lifetime benefit limits and annual limits.
Mental Health ProblemsMild to severe difficulties with mental or emotional functioning.
Mental DisordersAnother term used for mental health problems.
Mobile Treatment Team
Provides assertive outreach, crisis intervention, and independent-living assistance with linkage to necessary support services in the client's/patient's own environment. This includes PACT, CTTP, or other continuous treatment team programs.

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Help is always available! Clinicians are available 24/7 including holidays to provide immediate, seamless, in-the-moment support, as well as, crisis intervention and stabilization. Call us at 1 (855) 202-0973.