Medicaid Section 1115 and Home and Community Based Services Waivers

Waivers historically have been used to help improve health care of Medicaid enrollees, but some administrations have used them to restrict Medicaid

Medicaid section 1115 waivers allow states to examine innovative ways to deliver care by waiving certain requirements of the Medicaid Act. National Health Law Program works to ensure that states use Medicaid section 1115 waivers to conduct innovations that are consistent with the requirements of section 1115 (e.g., that they are indeed experiments) and are designed to improve access to health coverage.

Home and community based waivers, usually through section 1915 of the Social Security Act, allow states to provide targeted services to help people with disabilities and older individuals stay in their communities and out of institutions.

National Health Law Program works to ensure that states use waivers to conduct thoughtful innovations that can improve access to health care. We advocate with the federal government and support state advocates to develop strong policy proposals that comply with the law, and stop waivers that would harm Medicaid enrollees. Recently, states’ attempts to use section 1115 waivers to add work requirements, premiums, lock-outs and waiting periods through these waivers has led National Health Law Program to challenge HHS approvals of these waivers.  See “litigation” for more information.