CMS Approves 1115 Medicaid Waiver Extensions in Delaware, Tennessee

June 12, 2024
The two states are the first to provide diapers to young children covered by Medicaid

Extensions of 1115 Medicaid waivers recently approved by the Centers for Medicare & Medicaid Services (CMS) for Delaware and Tennessee are the first to provide diapers to young children covered by Medicaid.

The extension of Delaware’s Diamond State Health Plan Demonstration will  enable the state to provide three months of retroactive eligibility for all eligible Medicaid enrollees. The approval also adds three new benefits, which allow the state to: (1) Expand the state-funded pilot to provide home-delivered food and 80 diapers per week to postpartum members and babies, which will reach low-income postpartum members with disproportionately high rates of food insecurity and inequitable adverse maternal and birth outcomes; (2) Provide contingency management services for pregnant and post-partum Medicaid members with stimulant use disorder or opioid use disorder; and (3) Include children's dental services in the demonstration’s managed care delivery system. 

The program is designed to give Delaware families the healthiest start possible by reducing maternal stress, food and diaper insecurity during the critical postpartum period.

“The First State is one of the first in the nation to make the first months less stressful––and healthier––for new mothers through nutrition and diapering support,” said Andrew Wilson, Director of the Delaware Department of Health and Social Services (DHSS) Division of Medicaid and Medical Assistance, in a statement. “Allowing mothers to focus on caring for their babies and themselves instead of worrying about how to pay for diapers and meals will greatly help reduce stress, depression and anxiety, so they can focus on the health of their babies and their own postpartum care.”

Food-insecure mothers are more than twice as likely as their food-secure peers to report mental health problems, such as stress, depression, and anxiety, while caring for a newborn during the post-partum period. Food insecure mothers also experience decreased rates of breastfeeding, which can help protect babies against short- and long-term illnesses and disease, such as asthma, obesity, and diabetes.

Access to sufficient diapers also offers health benefits to the mother, as diaper need is associated with both maternal depression and stress. On average, newborn babies can require eight to 10 diapers a day, or around 300 a month. Ensuring adequate supply of diapers helps to prevent avoidable health care utilization and improves overall infant health, as frequent diaper changes are the mainstay of recommendations to prevent diaper rash and urinary tract infections.


In Tennessee, the amendment adds three new benefits: (1) Expansion of Medicaid eligibility for parents and caretaker relatives of dependent children up to 100 percent of the federal poverty level (FPL). By increasing Medicaid eligibility for up to 100 percent of the FPL, Tennessee will now provide Medicaid coverage for this group up to the FPL threshold at which individuals become eligible for federally subsidized premium assistance for health coverage available on the Federally Facilitated Marketplace (FFM). Closing the coverage gap between eligibility for the two health insurance programs helps to lower the uninsured rate and increase access to medically necessary health care.

 In addition, the amendment includes (2) Approval of a new benefit to provide coverage of 100 diapers per month per child, for families with children under the age of two; and (3) Authority for the state to make several home- and community-based services (HCBS) enhancements, with a focus on employment services and supports, to promote increased independence for individuals with disabilities in their homes, communities, and workplaces.

 

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