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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- February 9, 2023
NHeLP Comments on New Mexico 1115 Renewal Request
In comments to HHS, NHeLP focuses on select provisions related to long-term services and supports (LTSS) in New Mexico's renewal request. The comments focus on the State's plans to use Medicaid funds to pay for room and board in assisted living facilities and to alter existing nursing facilities. The comments address the lack of an experiment, the Secretary's authority, and the State's community integration obligations to people with disabilities.
- November 11, 2021
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.
- April 8, 2019
Webinar: Judge Vacates HHS Approvals of Medicaid Work Requirements in Kentucky & Arkansas
In a recent webinar, National Health Law Program Legal Director Jane Perkins and Senior Attorneys Catherine McKee and Elizabeth Edwards discussed the recent federal court decisions blocking work requirements and other coverage restrictions in the Kentucky and Arkansas Medicaid programs. They discussed the cases as well as key takeaways and unanswered questions. The National Health Law Program, along with national and state partners, challenged the HHS approval of Medicaid work requirements in Stewart v. Azar and Gresham v. Azar. Download the webinar below.
- April 16, 2015
Q&A: Person Centered Planning Changes
Due to regulatory changes and guidance issued over the past year, states should have evaluated and likely changed their person-centered planning process for home and community-based services. This Q&A focuses less on the regulatory changes and more on the important features of the current requirements for person-centered planning and how these features should positively affect the experience of the participant.
- August 28, 2014
Q&A HCBS – Transition Plan Advocacy: Identifying the Issues
This Q&A resource developed and written by NHeLP is for advocates working on, or considering, comments on State transition plans for Home and Community-Based Services (HCBS) programs. This document will help advocates: Identify changes needed in existing HCBS programs and the information within an organization that can be used to comment on transition plans for these programs; Understand the transition plan process and the connection to Olmstead advocacy; Develop inquiries by using the expertly crafted sample questions to ask when looking at a current HCBS program; Find compelling examples to demonstrate how current policies may not conform to the new standards in practice; and Identify the issue areas that may yield illustrations of current problems (e.g., services, housing or employment) as well as potential roadblocks that need to be addressed to ensure successful transition to more integrated services.
- February 18, 2014
Health Advocate: Home and Community Based Settings — A Primer
This issue of the Health Advocate provides an overview of Medicaid Home and Community Based Services (HCBS). HCBS programs are intended to support states in creating a comprehensive system of long-term care services in the community, as is consistent with the community integration mandate established by the Supreme Court in the Olmstead v. L.C. case in 1999.
- February 11, 2014
Q&A: Home and Community-Based Services-Final Rules
Q&A: Home and Community-Based Services-Final RulesMedicaid-funded home and community-based services are critical to community integration for older adults and individuals with disabilities. Defining the types of settings in which these services are provided is important in ensuring the services are not provided in settings that are institutional in nature, but instead promote access to the community. This Q&A discusses the new rules, the definition of home and community-based settings, the transition process, advocacy opportunities, and other new features for Medicaid waivers and programs under these new rules.
