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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… results in Waivers and Demonstrations.
  • July 23, 2013

    Comments to Arizona’s 1115 Waiver Amendment Request

  • July 23, 2013

    Due Process in California’s Early Medicaid Expansion Program

  • July 23, 2013

    Covering HCB Services through the 1915(i) State Plan Option

    Q. My state is considering asking CMS to approve Medicaid coverage of home and community-based (HCB) services through the 1915(i) state plan option. Can you explain what this option is and whether there are any particular issues that advocates should watch for?  A. Section 1915(i) enables to states to offer HCB services through a state plan option. This can be good for P & A clients, because it can increase access to HCB services for individuals who are not eligible for Medicaid waiver programs. At the same time, it can be a way for states to limit coverage of services to particular populations. Therefore, advocates need to closely monitor states? plans to offer 1915(i) services.    Discussion  In 2005, Congress added a new section to the Medicaid Act that authorizes states to provide HCB services to certain individuals through a state plan option.2 Previously, such home and community-based services could be offered only pursuant to an 1115 or 1915 waiver.3 The 1915(i) option enables states to serve individuals with incomes under 150% of FPL who need HCB supportive services but whose disabilities are less severe than those served under HCB waivers. Unlike waivers, individuals…

  • July 23, 2013

    1115-Copayment Waiver Amendment Attachments

  • July 23, 2013

    Limiting Cost-Sharing in Medicaid Funded Programs

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    Q. My state is considering implementing cost sharing for Medicaid beneficiaries, arguing that this will save money. The state wants to implement cost sharing above the nominal amounts listed in federal Medicaid regulations and to make payment of the copayments mandatory. It also wants to impose premiums on some Medicaid populations that exceed the premium amounts currently allowed in the Medicaid laws. We understand that the state is going to ask the federal Medicaid agency for approval of these changes. Are there arguments we can make against these cuts? Can you suggest evidentiary support for our legal position?   A. Yes. A recent decision from the Ninth Circuit Court of Appeals casts doubt on the state?s plan to impose the heightened cost sharing. Moreover, numerous studies have demonstrated that Medicaid cost sharing reduces utilization of necessary services and lowers enrollment. The imposition of premiums also implicates the maintenance of efforts requirements of the Affordable Care Act.   Discussion   Medicaid cost sharing rules Cost sharing requires a patient to pay part of the cost of health care services, such as enrollment fees, premiums, deductibles, coinsurance, copayments, or similar charges. Congress has been very…

  • July 23, 2013

    Duals Demonstration/Coordinated Care Initiative (CCI) As Amended by May Revise

    Kim Lewis

    Honorable Members  California State Legislature  Re: Duals Demonstration/Coordinated Care Initiative (CCI) As Amended by May Revise ? Concerns  The undersigned organizations have been active participants in the planning process for the Duals Demonstration Project, which was authorized by SB 208 (Statutes of 2010) as pilot programs in up to four counties. We have also written to oppose the Governor?s State Budget Proposal which proposed to expand the demonstration from four to ten counties as part of the Coordinated Care Initiative (CCI). In early May, several of our organizations individually gave input to the Department of Health Care Services (DHCS) and Department of Social Services (DSS) on our outstanding concerns regarding the State?s draft plan to the Centers for Medicare and Medicaid Services (CMS).  We continue to work collaboratively with the Administration and hope to see a demonstration which delivers on the potential for integrated funding and services for people who are dually eligible for Medi-Cal and Medicare. While we appreciate the proposed changes in the May Revision to delay implementation from January 1, 2013 to March 1, 2013 and to reduce the proposed expansion of pilots to eight counties, we must continue to oppose…

  • July 23, 2013

    NHeLP Comments: Medicaid Program; State Plan Home and Community-Based Services, 5-Year Period for Waivers, Provider Payment Reassignment, and Setting Requirements for Community First Choice

  • July 23, 2013

    Medicaid HCBS and 1115 Waivers

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  • July 23, 2013

    Q & A: Recent Settlements in Medicaid Home and Community-Based Waiver Cases

    Q & A: Recent Medicaid Settlements in Washington and Florida  On December 20, 2006, the Federal District Court for the Western District of Washington gave final approval to a far-reaching settlement agreement in a Medicaid home and community based waiver case. Boyle v. Braddock was filed in 2001 on behalf of a class of current and future participants in Washington?s Medicaid Home and Community Based Waiver programs for people with developmental disabilities. The plaintiffs claimed that Washington?s Division of Developmental Disabilities (DD) had violated Medicaid law by failing to advise waiver participants about the range of Medicaid services available; failing to provide services with reasonable promptness and denying waiver participants free choice of service alternatives available under the waiver. In addition, the plaintiffs claimed that they were not given due process when services were reduced, terminated or denied.  After several years of litigation, extensive discovery, appeal to the Ninth Circuit, and two separate formal mediation processes, the parties entered into the settlement agreement that was ultimately approved by the district court. The settlement provides that:    All waiver participants will have annual comprehensive needs assessments;  All waiver participants will have the opportunity to apply…

  • July 23, 2013

    SoonerCare 1115 Waiver Evaluation: Final Report Part 1

    External Source

    SoonerCare 1115  Waiver Evaluation:  Final Report  January 2009  James Verdier, JD  Margaret Colby, MPP  Debra Lipson, MHSA  Samuel Simon, PhD  Christal Stone, MPH  Thomas Bell, MBA  Vivian Byrd, MPP  Mindy Lipson  Victoria Pérez Submitted to:  Oklahoma Health Care Authority  4545 N. Lincoln Blvd., Suite 124  Oklahoma City, OK 73105  Project Officer:  Beth Van Horn  Submitted by:  Mathematica Policy Research, Inc.  600 Maryland Ave. S.W., Suite 550  Washington, DC 20024-2512  Telephone: (202) 484-9220  Facsimile: (202) 863-1763  Project Director:  Jim Verdier CONTENTS    Chapter Page     FINAL EVALUATION SUMMARY ........................................................................ xiii  I INTRODUCTION ..........................................................................................................1 A. PURPOSE ................................................................................................................1 B. METHODS ..............................................................................................................2   II SOONERCARE PROGRAM STRUCTURE AND HISTORY .....................................5 A. INTRODUCTION ...................................................................................................5 B. THE ORIGIN AND EARLY YEARS OF SOONERCARE: 1992 TO 1996 .........6 1. Search for a Solution to Burgeoning Medicaid Costs, 1992 and 1993 ............6 2. No Expansion of Medicaid Eligibility in Original SoonerCare Waivers.........8 3. The Oklahoma Health Care Authority .............................................................8 4. The SoonerCare Managed Care Program ........................................................9 5. 1997 Evaluation of Initial Implementation of SoonerCare…

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