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.
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- December 16, 2021
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 Even long-standing rules would be automatically rescinded unless they survive a complex process of assessment and review.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and the Children’s Health Insurance Program (CHIP) would be devastated if important regulations are arbitrarily rescinded.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.
- August 20, 2021
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.
- April 27, 2021
In this application, New Mexico seeks to waive the Institutes for Mental Disease (IMD) exclusion, implement High Fidelity Wraparound Services for an initially limited group of children and youth, institute a Graduate Medical Education Program, and establish vaccine coverage for limited beneficiary categories. For a variety of reasons, NHeLP suggests that the Secretary not approve this amendment request. In particular, NHeLP notes that the state has failed to provide evidence that many of these programs are genuine experiments. Further, HHS does not have the authroity to waive the IMD exclusion because the exclusion is found outside of 42 U.S.C. § 1396a. Additionally, waiving the IMD exclusion would undercut community-based mental health services. Finally, NHeLP notes that intensive care coordination services like High Fidelity Wraparound should be provided as a medically necessary service to all children and youth under the age of 21 through the state's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mandate.
- December 3, 2020
In the Regulations Rule, HHS seeks 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. Programs like Medicaid and the Children's Health Insurance Program (CHIP) could be devastated if important regulations are arbitrarily rescinded. In comments, NHeLP pushes back against this unlawful and ill-conceived proposal designed to sabotage HHS safety net programs.
- September 14, 2020
Guidance documents are a valuable tool that allows agencies to clarify policy issues and explain ambiguities raised by the laws and rules they are tasked with implementing. Programs like Medicaid and the implementation of the Affordable Care Act depend heavily on guidance documents to clarify coverage requirements and the obligations of state programs serving low income communities. However, a HHS proposed “good guidance " rule would open the door to the administration repealing important guidance without notice or explanation, and would create a time-consuming and burdensome process to reinstate or implement new guidance. In these comments, NHeLP explains why the proposed "good guidance" rule would be, in fact, harmful, and urge HHS to withdraw the proposed rule.