New York Medicaid Waiver 1915(b)

1915 (b) Waiver Basics

The 1915(b) waiver authority allows New York State to implement a managed care delivery system and require that Medicaid patients participate in managed care for some or all of their benefits (except for family planning). 1915(b) waivers permit the state to waive the statutory requirement granting patients the freedom to choose any provider who accepts Medicaid, use cost savings to provide additional services, designate a central entity to manage enrollment, or set limitations on the providers of specific services.

There are four (4) 1915(b) waivers:

  • (b)(1) Freedom of Choice – restricts Medicaid enrollees from receiving services within the managed care network
  • (b)(2) Enrollment Broker – utilizes a "central broker"
  • (b)(3) Non–Medicaid Services Waiver – uses cost savings to provide additional services to beneficiaries
  • (b)(4) Selective Contracting Waiver – restricts the provider from whom the Medicaid eligible may obtain services

The primary differences between a 1915(b) waiver program and a state plan program are that States are able to require dual eligibles, American Indians, and children with special health care needs to enroll in a managed care delivery system. States must demonstrate that the managed care delivery system is cost–effective, efficient and consistent with the principles of the Medicaid program. The approval period for the state's 1915(b) waiver program is limited to 2 years. (Medicaid state plan authority does not have an expiration date.)

Send all general inquiries regarding New York State 1915(b) waivers to