Health Care Reimbursement

Resources that explain the various aspects of health care reimbursement and help researchers find sources of information on payment rates

Medicaid Waiver States and Demonstration Projects

A number of states are operating under several different Medicaid waiver programs that allow those states to experiment with care delivery and financing models that are not consistent with the Medicaid program--but that may produce improved outcomes and/or more cost effective care.  Here is a link to the Center for Medicare and Medicaid Services' list of states that have waivers, are applying for waivers, and have been denied waivers.

Medicaid Waiver States

Medicaid Demonstration Projects: Follow link to federal Medicaid page and scroll down to "State Innovations."


Medicaid is a program established primarily to provide care to those without health insurance who are unable to afford care.  It is jointly administered by the federal government and each of the state governments.

The federal role involves:

  • Generating Medicaid regulations, based on federal law, that affect all the states or subsets of states
  • Providing technical guidance to state Medicaid programs
  • Sharing the funding of care

The states' role involves:

  • Establishing who is covered, within overall guidelines established at the federal level
  • Establishing which services are covered, within the overall guidelines and minimum coverage requirements established at the federal level
  • Establishing payment rates and mechanisms
  • Serving as an information source, advocate, dispute resolver, etc. for covered individuals and providers