Target Populations
Applicable Authorities
The target population you select has implications for the federal authority you use. Those implications are outlined below. See the Federal Authorities unit for more detail.
- Comparability and statewide availability. In general, federal Medicaid law requires states to provide comparable services to all beneficiaries statewide. Serving a targeted group of beneficiaries, such as those who have a particular condition or need, requires an exception to the comparability requirement, and offering an MLTSS program in selected parts of the state requires an exception to statewide availability. These are very common exceptions allowed under all of the managed care authorities and some of the LTSS authorities.
- Eligibility. If you want to expand financial eligibility as part of your MLTSS program, you will need to consider a waiver or state plan amendment. If you want to include the higher financial eligibility limits available under a traditional Section 1915(c) waiver or 1915(i) state plan amendment (e.g., up to 300% of the SSI level), you can do so by incorporating a new or existing Section 1915(c) waiver or 1915(i) state plan amendment into your program. If you want to include any other “expanded” eligibility group not available under an HCBS waiver or state plan amendment, you will need to seek a demonstration project.
- Integrating Medicare services. If your state decides to include Medicare-Medicaid beneficiaries and include Medicare-covered services in the program, then you need to consider Medicare authorities in addition to the Medicaid authorities. (You can include Medicare-Medicaid beneficiaries without Medicare authority, but only for Medicaid covered services.)
