Waiver 1115 Information

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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  • Finding and Analyzing Medicaid Quality Measures

    This brief provides tools to find the major sources of state and plan-level Medicaid quality data, to learn how to evaluate and compare results, and to use those skills to improve data transparency and to push your state to hold plans accountable to their mission: to manage care effectively and efficiently.

  • The Congressional Review Act: Frequently Asked Questions

    The CRA requires executive branch agencies to report their rulemaking activities to Congress and creates a process for Congress to overturn these federal rules. Until 2017, the CRA had been used only once to strike down a federal regulation. Following the 2016 elections, however, a Republican controlled Congress, under the Trump Administration, used the CRA to invalidate dozens of federal rules enacted under the Obama Administration. Given the on the outcome of the 2020 elections, the CRA could serve as an important tool for a new Congress and Administration to rescind actions of the Trump Administration. This issue brief will answer the following questions: • How can Congress use the CRA to disapprove administrative rules? • What types of actions are reviewable under the CRA? • What is a major rule? • What process does Congress use to review a rule that has not been reported to Congress? • Can an agency issue a similar rule if Congress disapproves a rule under the CRA? • What is the CRA “lookback period” and how is that calculated?

  • Meeting the Moment: Understanding EPSDT and Improving Implementation in California to Address Growing Mental Health Needs

    Children and youth across the country are facing an escalating mental health crisis. The events of 2020 have added new and complex stressors, exacerbating mental health challenges while also creating new barriers to accessing care. Unmet mental health needs have grave consequences for individuals, their families, and entire communities. Now more than ever, it is crucial that we have robust, well-functioning systems in place to identify and respond to children’s needs early, effectively, and equitably. Our "Meeting the Moment" paper is essential reading for anyone interested and engaged in supporting and protecting the health and welfare of children in California. This paper purposefully packs in a lot. It includes more than 150 source citations and fully and faithfully tracks the winding and inconsistent interpretation of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) entitlement in California with a particular focus on the support for the social, emotional, and behavioral health of children in Medi-Cal.

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