Mississippi officials got exactly what they wanted for Christmas from the Centers for Medicare and Medicaid Services (CMS): a 10-year extension of the Medicaid Section 1115 demonstration waiver. This means the state can continue providing family-planning services for people with income of up to 194 percent of the federal poverty level.

The decade-long extension is no fluke, but part of a broader effort to give states more flexibility and freedom when deciding the outcomes of their Medicaid programs without the need to beg the government for approvals.

Per a recap provided by Modern Healthcare, CMS typically granted Section 1115 waivers, "which are supposed to be budget-neutral for the federal government, for five-year periods." Apparently, the federal arm plans to use a new streamlined template for annual monitoring and reporting of the state's performance on the demonstration waiver program.

The Mississippi waiver is the first 10-year demonstration extension in the history of CMS, and it allows Mississippi to administer its Medicaid program without the inconvenience of obtaining routine approvals from CMS, said administrator Seema Verma. In her statement citing the decision, she reiterated her agency's desire to give states the flexibility they deserve to meet the needs of their people.

The waiver program provides additional benefits for family planning and related services for low-income women and men ages 13 through 44 not enrolled in Medicaid, Medicare, the Children's Health Insurance Program or other qualifying health plans that include family planning services.

Mississippi has not "expanded Medicaid to people with incomes up to 138 percent of poverty. If it did, many of the waiver beneficiaries would be able to receive family planning along with comprehensive health benefits through the regular Medicaid program."

Verma also said that CMS is expected to grant Medicaid waivers to other Republican-led states, meaning they can set cost-sharing, work and other requirements on low-income people as a condition for receiving health benefits. These states' leaders hope such waivers will reduce the number of people enrolled in Medicaid.

The CMS approval letter dated Dec. 28 did not indicate the total cost of the Mississippi waiver program or how many state residents would benefit from it. The waiver approval is effective through Dec. 31, 2027. Per the letter, CMS made several changes to the Mississippi Family Planning Medicaid Waiver Special Terms and Conditions (STCs) to reduce the state's administrative burden associated with the Section 1115 approval and monitoring processes while also assuring adequate federal oversight and evaluation.

"These STC updates streamline monitoring requirements to an annual reporting cycle and establishing templates for annual monitoring reporting, as well as for evaluating demonstration outcomes that will facilitate the state's data development, collection and reporting capacity," according to the letter.

CMS's approval of this demonstration project is subject to the state's compliance with a number of STCs and associated expenditure authorities.

"The state's authority to deviate from Medicaid requirements is limited to the expenditure authorities and requirements specifically listed as not applicable to the expenditure authorities described in the enclosed approval documents, and to the purpose(s) indicated."