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.
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- January 6, 2022
In 2017, the Centers for Medicare & Medicaid Services issued a policy announcing its intent to “approve the extension of routine, successful, non-complex” section 1115 waivers for a period of up to 10 years. Thereafter, CMS extended a number of projects for 10 years. This issue brief explains how the policy and the subsequent approvals are contrary to section 1115 and calls on the Biden administration to rescind the policy, reconsider the approvals, and adhere to the text of section 1115 moving forward.
- December 16, 2021
In the HHS SUNSET final rule, HHS sought to retroactively impose a mandatory expiration date on an estimated 18,000 duly promulgated regulations. Even long-standing rules would be automatically rescinded unless they survive a complex process of assessment and review. If implemented, programs like Medicaid and the Children’s Health Insurance Program (CHIP) would be devastated if important regulations are arbitrarily rescinded. In comments, NHeLP strongly supports the repeal of the HHS SUNSET final rule.
- November 30, 2021
Comments from the National Health Law Program opposing Montana's request for federal funding of mental health and SUD services in IMDs.
- November 11, 2021
In comments to the Department of Health and Human Services, NHeLP explains that the ARHOME project raises serious legal concerns. The application does not include a sufficient level of detail to allow for meaningful comment on several features of the project. What is clear from the application is that Arkansas is seeking permission to implement a number of policies - imposing premiums, waiving retroactive coverage, and restricting access to services through various mechanisms - that conflict with the core objective of the Medicaid Act and serve no experimental purpose.
- November 1, 2021
In comments to the Department of Health and Human Services, the National Health Law Program explains that the initial purpose of the Primary Care Network project, which started nearly 20 years ago as a way to expand coverage to population groups that were not described in the Medicaid Act at that time, has been lost. Currently, the project is a hodgepodge of features, many of which restrict coverage and access to care. As a result, we recommend that CMS take the following steps in response to Utah’s application: Where possible, CMS should require Utah to implement elements of the project through other authorities (the state plan or non-demonstration waiver authorities). CMS should then evaluate the remaining elements of the project in accordance with section 1115.
- November 1, 2021
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject New Hampshire's request to waive the Institutions for Mental Diseases (IMD) exclusion for certain psychiatric facilities.
- August 20, 2021
In the Updating Payment Parameters Rule (UPP Rule), the Centers for Medicare & Medicaid Services proposes several important changes to enrollment in the Affordable Care Act (ACA) Marketplaces. These changes include extending the open enrollment period, establishing a year-around Special Enrollment Period for low income persons, restoring key features of the Navigator program such as providing consumers assistance in using their plans, ending the abortion double-billing provision, and restoring guard rails for Section 1332 waivers. NHeLP comments express strong support for these changes, and suggest areas where CMS can go even further to help consumers and reduce the number of insured people.
- August 18, 2021
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Maryland’s request to waive the Institutions for Mental Diseases (IMD) exclusion for certain private psychiatric facilities.
- July 15, 2021
In 2020, the COVID-19 pandemic plunged the United States into a public health crisis. This situation was not entirely unprecedented. Local crises had previously been triggered by events such as hurricanes (e.g., Katrina in 2005, Irma in 2017), wildfires (e.g., California in 2017 and 2018), lead contamination (Flint, Michigan in 2016), and terrorist attacks (New York City after 9/11). During these events, the Secretary of the Department of Health and Human Services (HHS) used waiver authority to allow affected states to ignore otherwise mandatory Medicaid requirements so that they could use Medicaid as part of the emergency response. These crises, and particularly the COVID-19 pandemic, have made it clear that the current statutes do not give HHS sufficient emergency waiver authority. This paper: Outlines legal authorities that allow HHS and states to adjust their Medicaid programs during an emergency; Identifies deficiencies in these authorities; and Makes recommendations that, if implemented, will better prepare Medicaid programs for the next crisis. The two authorities that HHS and states have turned to the most during emergencies are Section 1115 and Section 1135 of the Social Security Act.
- June 16, 2021
Tension and confusion can arise over how HHS allows states to change their Medicaid programs, whether through a state plan amendment (SPA) or a Section 1115 project. To help guard against the improper use of Section 1115 waivers, advocates must know the distinctions between Section 1115 waivers and SPAs. This primer outlines these distinctions.