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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.

July 23, 2013
Medicaid HCBS and 1115 Waivers
Jane Perkins and Sarah Somers Presentation
For full publication text, download document.
July 23, 2013
Q & A: Recent Settlements in Medicaid Home and Community-Based Waiver Cases
Sarah Somers Issue Brief
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 Manual/Report
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…
July 23, 2013
SoonerCare 1115 Waiver Evaluation: Final Report Part 2
External Source Manual/Report
This report describes the SoonerCare 1115 Waiver program including participation rates, quality measures, and financial outcomes.
July 23, 2013
SoonerCare 1115 Waiver Evaluation: Presentation to Oklahoma Health Care Authori
External Source Presentation
For full publication text, download document.
July 23, 2013
Restrictions on the Scope of Section 1115 Waivers in the Medicaid Program
dfitzgerald Issue Brief
Restrictions on the Scope of Medicaid Waivers Under ' 1115 of the Social Security Act In August, 2001, the Centers for Medicare and Medicaid Services (CMS) announced the Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative. HIFA encourages states to seek waivers of various provisions of the Medicaid Act and the State Children=s Health Insurance Program in order to expand basic health insurance coverage to groups not currently eligible to receive benefits under those programs. In return, CMS has promised the states fast-track consideration of their waiver requests, and the "flexibility" to limit the benefits and rights of some current recipients in order to meet CMS= requirement that any expanded coverage not cost the federal government any more money than it is now paying to a state. With HIFA, CMS has once again focused attention on its powers under ' 1115 of the Social Security Act (42 U.S.C. '1315) to waive various provisions of the Medicaid Act in furtherance of "demonstration projects." This paper examines some of the substantive and procedural limitations on those powers. The language of ' 1115 provides the starting point for any analysis of the scope of CMS= waiver authority. It states,…
July 23, 2013
HIFA: Will It Solve the Problem of the Uninsured?
dfitzgerald Issue Brief
HIFA: Will It Solve the Problem of the Uninsured?
July 23, 2013
What is HIFA and Why Should We Be Concerned?
dfitzgerald Issue Brief
In August, 2001, the Centers for Medicare and Medicaid Services (CMS) announced the Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative. HIFA encourages states to seek waivers of various provisions of the Medicaid Act and the State Children?s Health Insurance Program (SCHIP) to expand basic health insurance coverage to groups not currently eligible to receive benefits. In return, CMS has promised the states fast-track consideration of their waiver requests. However, CMS has also required that a state?s resulting waiver program, with the expansion in coverage contemplated by HIFA, must not cost the federal government any more money over the life of the waiver than it would have paid without the waiver. In this time of state budget stress, it is likely that this budget neutrality requirement will result in significant benefit cuts for those already receiving assistance, cost-sharing requirements beyond those authorized by the statute (in a provision that is not properly subject to waiver), and/or the imposition of enrollment caps and waiting lists in Medicaid. HIFA divides Medicaid and SCHIP recipients into three groups: mandatory, optional, and expansion. Those in mandatory groups (see Mandatory vs. Optional Eligibility in Medicaid)…
July 23, 2013
Letter to HHS Secretary Thompson from Senators Baucus and Grassley
External Source Letter
Letter to HHS Secretary Thompson from Senators Baucus and Grassley
July 23, 2013
Response Letter from HHS Secretary Thompson to Senators Baucus and Grassley
External Source Letter
Response Letter from HHS Secretary Thompson to Senators Baucus and Grassley