The Department of Health Care Services must obtain approval from the federal government to administer Medi-Cal waivers. Requests for new waivers usually require prior State Legislative authorization.​​ 

The criteria used by the federal government for approval of Medicaid waivers are generally based upon policy – DHHS’ and particularly CMS’ interpretations and applications of Medicaid law and regulations – rather than solely on the law. The most significant requirement is that of cost-effectiveness or budget neutrality. The proposed changes must not cost the federal government more than the expected Medicaid costs for the traditional Medicaid population under the same time period.​​ 

Section 1915 waivers must not exceed fee-for-service equivalent costs. These waivers do not need to result in cost savings to be budget neutral during the waiver period as long as the costs do not exceed the federal fee-for-service equivalency.​​ 

第 1115 条豁免必须证明实际成本将会降低，或者在豁免期间支出的增长率将比没有豁免时更慢。​​ 

豁免一览​​ 

联邦要求豁免​​	1915（生）​​  自由选择豁免​​  全州​​  服务兼容性​​  供应商选择​​	1915年（三）​​  家庭和社区服务豁免​​  全州​​  服务兼容性​​  收入和资源标准​​	1115 研究和示范豁免​​  医疗补助规则范围广泛​​
审批流程​​	来自具有严格审核时间表的 CMS​​	来自经过严格审核的 CMS​​	来自卫生和公共服务部，没有具体的审查时间表​​
时间段​​	首次豁免期为两年​​  两年延期​​	首次豁免期为三年​​  五年延期​​	首次豁免期为五年​​  全州计划延长三年​​  其他项目延长一年​​
使用示例​​	管理式护理​​	老年人和残疾人机构护理的替代方案​​	扩大资格上限​​  管理式护理​​