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

results in Waivers and Demonstrations.
  • Medicaid, Child Welfare & Institutional Care: Qualified Residential Treatment Programs

    A landmark foster care reform law, the Family First Prevention Services Act, was intended to ensure that children are able to live in family-like settings and reduce reliance on unnecessary institutional care. In doing so, the new law put a spotlight on a longstanding Medicaid law and policy that prohibits states from obtaining federal funds for services provided to residents of mental health facilities with more than 16 beds. This exclusion has existed since Medicaid was enacted in 1965, and plays an oft misunderstood and underappreciated role in incentivizing states to provide services in smaller, more community-based settings. This issue brief discusses the intersection of the IMD exclusion with foster care placements and advocates for a path forward where federal funding continues to be used to further the goal of keeping children with families.

  • NHeLP comments on Oregon’s application for renewal of the Oregon Health Plan § 1115(a) Demonstration Waiver for 2022-2027

    In public comments, NHeLP expresses support for Oregon's decision to abandon its waiver of EPSDT. However, NHeLP strongly opposes Oregon's proposal to exclude outpatient prescription drugs approved under the FDA's accelerated approval pathway. Denying Medicaid enrollees access to effective break-through therapies would harm people with serious or life-threatening medical conditions. NHeLP also expresses concern about implementation of the EPSDT waiver withdrawal, and opposes the continued use of the prioritized list for children and adults.

  • NHeLP Comments on Georgia Section 1332 State Innovation Waiver

    NHeLP submitted comments during the reopened comment period regarding Georgia's Section 1332 State Innovation Waiver. NHeLP recommends that HHS withdraw its approval of this waiver because it would impose a number of unlawful conditions on coverage and access to care for the marketplace and Medicaid populations.

  • Section 1115 Waivers: Stop the Ten-Year Approvals

    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.

  • NHeLP Comments on HHS SUNSET Repeal Rule

    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.

  • NHeLP Comments on Montana 1115 Waiver Request – IMD Exclusion

    Comments from the National Health Law Program opposing Montana's request for federal funding of mental health and SUD services in IMDs.

  • Comments: Arkansas Health and Opportuinty for Me (ARHOME) Demonstration Application

    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.

  • Comments: Utah Primary Care Network Extension Request

    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.

  • Comments: New Hampshire Section 1115 Demonstration Amendment Request

    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.

  • NHeLP comments on Updating Payment Parameters Rule

    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.

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