Gov. JB Pritzker's administration has applied to the federal government to extend Illinois’1115 waiver for behavioral health services, with officials saying it will help with their goal of “healthcare transformation.”

The five-year extension application to the Centers for Medicare and Medicaid Services proposes 10 programs. Along with continuing four pilots originally approved by the agency in 2018 related to substance use disorder services, the waiver seeks to address food and nutrition services, employment assistance, non-medical transportation and community reintegration for previously incarcerated individuals.

“The section 1115 demonstration request is an essential component of Illinois’s strategic plan to build an equitable and sustainable healthcare system,” Pritzker wrote in a letter to Health and Human Services Secretary Xavier Becerra. “This comprehensive initiative will leverage the existing transformation framework of the 1115 demonstration activities within the current program to include additional foundational innovations to address the health-related social needs of Illinoisans.”

CMS originally approved the state’s 1115 waiver in 2018, granting the Department of Healthcare and Family Services the ability to implement 10 pilot programs to address the state’s behavioral health system. The initial goal, officials said, was to pilot treatments for addiction to opioids and other substances that were not directly available to Illinois Medicaid beneficiaries.

But numerous factors in recent years, ranging from the COVID-19 pandemic and its challenges to Pritzker being elected after the initial waiver was submitted, have changed priorities.

Officials are now seeking to rename the plan the Illinois Healthcare Transformation Section 1115 Demonstration to “better align with the state’s overall goal and current efforts to create an equitable and sustainable healthcare system for Illinoisans.”

“(HFS) now seeks to leverage Section 1115 Demonstration authority to secure additional Medicaid resources to sustain the groundbreaking work already underway and seed additional innovations,” according to the application.

CMS said late last month that they have extended the state’s demonstration through next June as the two sides continue negotiations over the current extension application.

The federal public comment period will be open until July 28.

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