Mercer Government Human Services Consulting

Hot Topics in Health Care Reform

HCBS Rules - 1915(c) waivers


Medicaid mandates some services and states may elect to provide optional services. Among the option benefits or services that states may elect to cover are HCBS, now available through a number of authorities/provisions of the Social Security Act. Section 1915(c) of the Social Security Act, originally enacted in 1981 (with some amendments since) has been the predominant vehicle for the delivery of HCBS, with more than 300 waivers nationally serving more than 1 million individuals annually. In FY 2011, 1915(c) waivers accounted for $37,927,274,607 or nearly 60% of all non-institutional long-term services and supports spending.


Title XIX permits the Secretary of Health & Human Services, through CMS, to waive certain provisions required through the regular state plan process.


The 1915(c) waivers permit states to provide HCBS to people who would otherwise require care in a nursing facility, intermediate care facilities for the mentally retarded or hospital. It is the major tool for meeting rising demand for long-term care supports and services. It serves diverse target groups and allows for participant-direction of services.

Every State offers HCBS under at least one authority and will be impacted. Each state has or will need to analyze their current programs to determine issues such as:

  • Whether the current HCBS settings meet CMS requirements and if not, the transition process to ensure compliance
  • Determine whether changes to the settings requirements will  have a financial impact on providers (i.e., reimbursement rates)
  • Incorporate the new person-centered planning requirements in your home and community-based programs
  • Determine whether streamlining of waivers under one authority or fewer authorities is right for your program(s)
  • Determine whether there is a financial impact


If you have questions or are concerned about your State's readiness, please contact the Mercer Government consultants at m...@mercer.com


Mercer GHSC is hiring!

Our success is a direct result of our intellectual capital. Mercer GHSC staff are responsible for the continuing growth of our organization and the reason our clients trust our expertise. We are always seeking highly qualified, talented and motivated candidates. Check our career information here for details on current job openings and job descriptions.

GHSC Solutions

View our updated service documents for Health Care Exchanges, Reform and the ACA Implications on our Solutions page.

GHSC presented at annual National Home & Community Based Services (HCBS) conference in September

Mercer presented two topics at this year's HCBS conference in conjunction with its state clients, Delaware, North Carolina and Louisiana. The two topics covered were Medicaid Managed Long Term Services and Supports and Using Home & Community Based Rate Development and Individual Budget Allocation Strategies in a Person-Centered System of Care. If you would like a copy of the presentation(s), please email Mercer.


Supreme Court decision on the constitutionality of the health care law

The Major Provisions of the ACA

  • The individual mandate, and
  • Medicaid eligibility expansion up to 133% of FPL


The Court's Decision

  • The individual mandate is constitutional and was upheld under the federal taxing authority
  • The mandatory nature of the Medicaid eligibility expansion is unconstitutional. States now have the option to expand Medicaid eligibility or not and the federal government cannot withhold existing Medicaid funds from states that decline to expand Medicaid eligibility up to 133% of the Federal Poverty Level (FPL)

View Mercer's detailed information on the impact of ACA here 


Hot topics 

Click on the buttons below for detailed information. 

Health Care Reform   Health Insurance Exchanges Capitation Rates: Fraud and Abuse


GHSC Announcements

Sam Espinosa selected as new GHSC Phoenix Office Leader

Sam Espinosa is a Principal with GHSC focusing on rates for special populations and new managed care initiatives. His expertise is actuarial analyses strategy and negotiations. Sam has been a leader of Mercer's Long Term Care rate team.


As the new office leader for GHSC's largest office, he will lead over 100 team members and manage the strategy for the practice.

Branch McNeal selected as new National Practice Leader

Branch McNeal is a Senior Partner at Mercer Government Human Services Consulting. Branch joined GHSC in 2002 and is an invaluable resource to his state and Federal clients, along with his cohorts throughout Mercer. He has been accountable for multiple Medicaid, CHIP and Medicare engagements. Client rely on his extensive financial and executive management knowledge of Medicaid and Medicare. Branch is adept in helping clients to fully understand the scope of an issue or project and the ability to recognize operational issues that may result from contemplated actions.


As the National Practice Leader, Branch will continue the focus of growth for the practice including the retention and recruitment of the group's key resource - the highly skilled and talented staff.

Former National Practice Leader, Mark Hoyt, retires

Long considered the founding father of the GHSC practice within Mercer, Mark Hoyt has shared his vast knowledge and support of the public health care system over the last 27 years in GHSC. His contagious enthusiasm and belief in the mission of this organization is greatly responsible for its success. We know that clients and staff alike wish him well in his retirement, knowing that he will never be completely out of sight or out of mind. Best wishes, Mark!


Basic Health Program

HELD October 19, 2011

Mercer GHSC held a national webcast on the Basic Health Program options for states. Access to the presentation, recording and other information on BHP can be found here. You may also email GHSC for assistance at <...@mercer.com.


Mercer GHSC has worked with more than

35 states and the federal government

Our History

What we do...

Where we began...

Mercer Government Human Services Consulting (GHSC) specializes in creating innovative solutions to transform health care.


We assist government-sponsored programs in becoming more efficient purchasers of health and welfare services. Mercer teams include actuaries, accountants, clinicians, and information technology professionals who can assure a coordinated approach to actuarial, financial, administrative, and operational components of public-sponsored health and welfare programs.

Mercer has a long history of consulting to large public sector clients.


Beginning in 1985, a group of consultants within Mercer began working with Medicaid programs across the country, helping those states design, develop and implement innovative solutions to improve quality of care while saving state general fund dollars.


In 1992, after seven years of working to meet the specialized needs of publicly-sponsored health and welfare programs such as Medicaid, high-risk health insurance pools and statewide health care reform initiatives, Mercer formally established a separate consulting practice – Mercer GHSC.


Mercer Government is a proud holder of a Federal Supply Schedule MOBIS contract


Contract GS-10F-0262L

Contact:  Mike Priniski 


Mercer Government Human Services Consulting (GHSC) is working with states and the Federal government in health care reform and beyond!


Our team of actuaries, consultants, clinicians and policy staff put us in a key position to assist states through the challenges of ACA. Please take a moment to review our experience and our staff - and contact GHSC for further information. We are here to help navigate the changing landscape.



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