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  • Writer's pictureHC3

1115 Medicaid Waiver Demonstration: A Path to Equity

In 2018, the Illinois Department of Healthcare and Family Services (HFS) launched an ambitious strategy to improve behavioral health outcomes through an 1115 Medicaid Waiver Demonstration. The waiver allowed Illinois to introduce ten pilot programs to improve health outcomes for patients needing support for behavioral health and/or substance use disorders (SUD). The pilots sought to provide:

  • Residential and inpatient treatment

  • Clinically managed withdrawal management services

  • SUD case management

  • Peer recovery support services

  • Crisis intervention services

  • Evidence-based home visiting services

  • Assistance in community integration services

  • Supported employment services

  • Intensive in-home services

  • Respite services

All pilots focused on various levels of care and attempted to support patients and caregivers across the continuum of care. However, several factors impacted these demonstration pilots, including:

  • Changes to Illinois’ Medicaid behavioral health landscape with the consolidation of programs to streamline care across the state

  • Illinois gubernatorial election in November 2018 yielding a change in administration

  • Secretary of the U.S. Department of Health and Human Services declared a public health emergency (PHE) for the United States, which caused the state of Illinois to shift focus to addressing the health care community’s response to the COVID-19 pandemic

Despite the pandemic’s disruption to health and social services, several of these pilots effectively supported access to critical services for Medicaid beneficiaries in residential and inpatient treatment settings, who would not have otherwise qualified for federal funding. Data shows that Medicaid enrollees had access to:

  • Treatment and withdrawal management services for SUD to increase ongoing treatment and recovery

  • Peer recovery supports counseling to prevent relapse and promote recovery

  • And, case management services for individuals with an SUD who requested diversion from the criminal justice system

Despite some of the progress made, there continue to be inequities that some policies and practices perpetuate. The updated 1115 Medicaid Waiver Demonstration aligns with Governor Pritzker’s Healthcare Transformation plan to achieve an equity-driven health care system that targets investments in underserved communities, increases access, and creates innovative collaborations to bridge service delivery gaps.


The current 1115 Medicaid Waiver Demonstration application outlines efforts to address:

  • SUD Services in Institutions for Mental Diseases

  • SUD Case Management

  • Housing Support

  • Employment Assistance

  • Medical Respite

  • Food and Nutrition Services

  • Violence Prevention and Intervention

  • Non-Medical Transportation

  • Justice-involved Community Reintegration

  • Transitioning from Incarceration

  • Community Reintegration

  • Transitioning from Institutions

If CMS grants approval for the proposed activities, several modifications from the previous waiver’s programs will be more strategically focused on effectively nurturing a health care system that promotes equity, fairness, and inclusivity. These changes encompass a more whole-person-care-centered approach to closing disparities in accessing high-quality health care services, mitigating differences among diverse demographic groups, and improving the overall health outcomes of marginalized communities.


From HC3’s ongoing partnership with Acclivus to address violence prevention and intervention to elevating strategic conversations and ideas with advocates to advance more housing support, we see that there is a strong correlation for these updates to be impactful and additive to some of the collective efforts already happening with HC3 and our partners.

Contributors to this post include:

Jordana Choucair, Senior Vice President of Communications, Third Horizon Strategies

Meghan Philipp, Executive Director, HC3

Chasity Wells-Armstrong, Strategic Consultant to HC3

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