Background Paper

Shaping Public Programs through Medicare, Medicaid, and SCHIP Waivers: The Fundamentals
September 15, 2003


Cynthia Shirk, Consultant


This background paper examines the use of research, demonstration, and program waiver authorities to test new approaches to the delivery of and payment for health care services in federally financed health coverage programs such as Medicare, Medicaid, and the State Children’s Health Insurance Program. The paper also looks at the mechanics of waivers as well as their history and political context in shaping public programs. In addition, it explores the ways the changing state-federal relationship and the ever-growing demand for state flexibility have driven waiver policy.

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