Section 1115 Medicaid waivers allow states to explore new options for providing health coverage to persons who would otherwise not be eligible and allow states to examine innovative ways to deliver care by waiving certain requirements of the Medicaid Act.
While waivers can be important tools that can help states respond to the needs of low-income individuals, they also present concerns for health advocates working to protect the rights of Medicaid enrollees and promote transparency in state waiver processes.
Sec. 1115 of the Social Security Act allows the Secretary of Health and Human Services to waive some requirements of the Medicaid Act so that states can test novel approaches to improving medical assistance for low-income people.
Under the current administration, several states are seeking waivers to impose harmful cuts and restrictions. The first set of harmful waivers have been approved for Kentucky and Arkansas, with a number of states seeking to enact similar changes to Medicaid. Learn more about Medicaid waivers and how the National Health Law Program is combating the Trump administration’s illegal use of waivers to weaken Medicaid.
View 1115 Waiver Resources By State
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- District of Columbia
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- West Virginia
- March 25, 2020
Comments: Coordinating Care from Out-of-State Providers for Medicaid-Eligible Children with Medically Complex Conditions
The Centers for Medicare and Medicaid Services issued a Request for Information on access to care across state lines in Medicaid for children with medical complexity. NHeLP submitted comments which highlighted the importance of access to durable medical equipment while out-of-state, and emphasized the importance of adequate community-based services. NHeLP also requested that the comment deadline be extended until after the coronavirus national emergency has passed, to permit more stakeholder input.
- March 24, 2020
Multiple courts have held it unlawful to condition Medicaid coverage on a work requirement. Yet, some states continue to consider them. In addition to the litigation history to date, policymakers in those states should consider the practical realities of work requirements. This fact sheet looks at some of the significant costs associated with administering work requirements.
- March 19, 2020
These comments were submitted in response to Notice 2018-12, in which the Internal Revenue Service (“IRS”) requested comments on the appropriate standards for preventive care under § 223(c)(2)(C) of the Internal Revenue Code of 1986 and "other issues related to the provision of preventive care” under a high deductible health plan. Our comments strongly recommend that the IRS and the Treasury Department issue guidance clarifying the definition of “preventive care” under § 223(c)(2)(C) to include all contraceptive drugs, devices, and sterilization procedures recognized by the U.S. Food & Drug Administration, as well as patient education and counseling, because all of these methods are designed and used to prevent unintended pregnancies.