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 by Cathren Cohen in Waivers and Demonstrations.
  • November 30, 2021

    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.

  • November 5, 2021

    NHeLP Comments on SUPPORT Act Section 1003 Demonstration

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    The Substance Use Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act requires the Department of Health and Human Services (HHS) to conduct a demonstration to increase the capacity of Medicaid providers to deliver substance use disorder (SUD) services. In comments to HHS, NHeLP urges the administration to ensure the demonstration centers beneficiaries in addition to providers; emphasizes availability or lack thereof of community-based services; surveys the harms of utilization management limitations on access to treatment for SUD; and evaluate compliance with EPSDT requirements. Finally, NHeLP calls on HHS to evaluate the impact of the projects on reducing health disparities.

  • April 27, 2021

    Alabama Section 1115 Institutions for Mental Disease Waiver for Serious Mental Illness Comments

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    In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Alabama’s proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. First, the Secretary may only waive requirements of the federal Medicaid Act to conduct an experiment or test a novel approach to improve medical assistance for low-income individuals, and Alabama has not proposed a genuine experiment or novel approach. Second, Alabama asks the Secretary to waive provisions of the Medicaid Act the Secretary does not have the authority to waive. Section 1115 only permits the waiver of those requirements found in 42 U.S.C. § 1396a, and Alabama requests a waiver of provisions outside of 42 U.S.C. § 1396a, including the “Institution for Mental Diseases” (IMD) exclusion. Third, Alabama’s proposal risks diverting funds away from community-based services, undermining decades of progress toward increased community integration. Last, Alabama proposes several reforms that simply do not require any wavier of the Medicaid Act. Such reforms should be pursued outside of the context of a waiver.

  • October 7, 2020

    NHeLP Comments on Oklahoma Section 1115 Institutions for Mental Disease (IMD) Waiver for Serious Mental Illness/Substance Use Disorder

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    NHeLP urges the Secretary not to approve the requested waiver because 1) Oklahoma asks the Secretary to waive provisions of the Medicaid Act the Secretary does not have the authority to waive; 2) Oklahoma has not proposed a genuine experiment or novel approach; 3) Oklahoma’s proposal risks diverting funds away from community-based services, undermining decades of progress toward increased community-integration; and 4) the Secretary does not have authority to approve a Section 1115 waiver that would enable Qualified Residential Treatment Programs (QRTPs) to receive federal financial participation (FFP) for psychiatric treatment for individuals under 21 with SMI.

  • September 17, 2020

    Utah 1115 IMD Demonstration Request Comment

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    Utah has applied for an 1115 demonstration waiving the IMD exclusion for people with serious mental illnesses. NHeLP submitted a comment opposing the demonstration request.

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