Wraparound Benefits in Premium Assistance Demonstrations

Wraparound Benefits in Premium Assistance Demonstrations

Medicaid 1115 Demonstrations Brief
Published: Sep 01, 2017
Publisher: Baltimore, MD: Centers for Medicare & Medicaid Services
Associated Project

New Approaches for Medicaid: The 1115 Demonstration Evaluation

Time frame: 2014-2020

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services


Maggie Colby

Arkansas, Iowa, and New Hampshire expanded Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level using section 1115 authority to support beneficiaries’ purchase of coverage from qualified health plans. These premium assistance demonstrations must ensure that beneficiaries have access to certain Medicaid benefits not typically covered by qualified health plans, such as the Early and Periodic Screening, Diagnostic, and Treatment services for 19- and 20-year-olds and family planning services from any willing provider. In this brief, we review the requirements for these “wraparound” benefits, assess the status of their implementation, and discuss their implications for Medicaid beneficiaries’ access to care.

All three states implemented wraparound benefits using procedures that are like the ones they use to administer wraparound benefits in their other premium assistance programs, notably their Health Insurance Premium Payment programs. All three states chose to give beneficiaries a Medicaid card to present to providers, who then bill the state for the wraparound benefits. States’ demonstration monitoring reports to the Centers for Medicare & Medicaid Services do not provide sufficiently detailed data to assess wraparound benefit utilization and associated administrative costs, although the upcoming national evaluation of section 1115 demonstrations will include an analysis of wraparound benefit claims.

How do you apply evidence?

Take our quick four-question survey to help us curate evidence and insights that serve you.

Take our survey