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.
  • Case Summary: Georgia v. Brooks-LaSure – Medicaid Work Requirements Reappear

    and Erica Turret* , ,

    A federal court in Georgia has set aside a decision by the Centers for Medicare & Medicaid Services (CMS) that had rescinded the work requirement and premium components of a section 1115 Medicaid project. The US Department of Justice did not appeal the ruling. Georgia becomes the only state in the country currently allowed to implement a Medicaid work requirement. This issue brief reviews the case, Georgia v. Brooks-LaSure, No. 2:22-cv-6, 2022 WL 3581859 (S.D. Ga. Aug. 19, 2022). *Erica Turret is a Jenner & Block Pro Bono Fellow at the National Health Law Program

  • NHeLP Comments on California Section 1115 Demonstration Five-Year Renewal and Amendment Request: CalAIM Demonstration

    In comments to HHS, NHeLP urges the Secretary to reject California's plan to renew its Institution for Mental Diseases (IMD) waiver for Medi-Cal beneficiaries with SUD. The comments emphasize concerns with flexibilities sought by the State to allow for longer stays at IMDs for both minors and adults. In addition, NHeLP's comments demonstrate support for several new services, such as peer support services, but caution that the use of a Section 1115 waiver instead of a state plan amendment is inappropriate. Finally, NHeLP urges both California and HHS to require all counties to participate in the expanded SUD program.

  • Comments on Missouri Section 1115 Request for Federal Funding for Institutions for Mental Disease (IMDs) for Children and Adults

    In these comments, NHeLP urges HHS to reject Missouri's request for federal financial participation for institutions for mental disease, as increasing federal funding for institutional care risks serious harm, particularly for children. NHeLP objects to the use of Section 1115 for this purpose, and to the request to eliminate time limits on length of stay for children for up to two years.

  • Washington Medicaid Transformation Project Demonstration Extension Request

    In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to ensure that appropriate guardrails are placed on any Medicaid funding for prison, jail, and other institutional re-entry, to ensure that it is used strictly for services that aid in reentry and that is primarily used for home and community based services. We also urge HHS to reject Washington's request to waive the Institutions for Mental Diseases (IMD) exclusion for certain psychiatric and substance use disorder facilities.

  • Washington Medicaid Transformation Project Demonstration Extension Request

    In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to ensure that appropriate guardrails are placed on any Medicaid funding for prison, jail, and other institutional reenty, to ensure that it is used strictly for services that aid in re-entry and that is primarily used for home and community based services. We also urge HHS to reject Washington's request to waive the Institutions for Mental Diseases (IMD) exclusion for certain psychiatric and substance use disorder facilities.

  • NHeLP Comments on West Virginia Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorders (SUD) Demonstration Extension Request

    Hector Hernandez-Delgado

    In comments to HHS, NHeLP urges the Secretary to reject West Virginia's Section 1115 demonstration extension request to continue waiving the Institutions for Mental Diseases (IMD) exclusion. This letter emphasizes that while NHeLP is supportive of efforts to increase access to services for Medicaid beneficiaries with substance use disorders (SUD), the Secretary has no statutory authority to waive the exclusion, particularly to extend demonstrations with no particular experimental value. In addition, several policy reasons are given to underscore the need to prioritize other more effective efforts that pose less risk of subjecting beneficiaries to harmful institutionalization.

  • Medicaid, Child Welfare & Institutional Care: Qualified Residential Treatment Programs

    A landmark foster care reform law, the Family First Prevention Services Act, was intended to ensure that children are able to live in family-like settings and reduce reliance on unnecessary institutional care. In doing so, the new law put a spotlight on a longstanding Medicaid law and policy that prohibits states from obtaining federal funds for services provided to residents of mental health facilities with more than 16 beds. This exclusion has existed since Medicaid was enacted in 1965, and plays an oft misunderstood and underappreciated role in incentivizing states to provide services in smaller, more community-based settings. This issue brief discusses the intersection of the IMD exclusion with foster care placements and advocates for a path forward where federal funding continues to be used to further the goal of keeping children with families.

  • NHeLP Comments on Healthy Louisiana Substance Use Disorder 1115 Demonstration Extension Request

    Hector Hernandez-Delgado

    In comments to HHS, NHeLP urges the Secretary to reject Louisiana's Section 1115 demonstration extension request to continue waiving the Institutions for Mental Diseases (IMD) exclusion. This letter emphasizes that while NHeLP is supportive of efforts to increase access to services for Medicaid beneficiaries with substance use disorders (SUD), the Secretary has no statutory authority to waive the exclusion, particularly to extend demonstrations with no particular experimental value. In addition, several policy reasons are given to underscore the need to prioritize other more effective efforts that pose less risk of subjecting beneficiaries to harmful institutionalization.

  • NHeLP Comments on Pennsylvania SUD Demonstration Extension

    In comments to HHS, NHeLP urges the Secretary to reject Pennsylvania's Section 1115 demonstration extension request to continue waiving the Institutions for Mental Diseases (IMD) exclusion. This letter emphasizes that while NHeLP is supportive of efforts to increase access to services for Medicaid beneficiaries with substance use disorders (SUD), the Secretary has no statutory authority to waive the exclusion, particularly to extend demonstrations with no particular experimental value. In addition, several policy reasons are given to underscore the need to prioritize other more effective efforts that pose less risk of subjecting beneficiaries to harmful institutionalization.

  • NHeLP comments on Oregon’s application for renewal of the Oregon Health Plan § 1115(a) Demonstration Waiver for 2022-2027

    In public comments, NHeLP expresses support for Oregon's decision to abandon its waiver of EPSDT. However, NHeLP strongly opposes Oregon's proposal to exclude outpatient prescription drugs approved under the FDA's accelerated approval pathway. Denying Medicaid enrollees access to effective break-through therapies would harm people with serious or life-threatening medical conditions. NHeLP also expresses concern about implementation of the EPSDT waiver withdrawal, and opposes the continued use of the prioritized list for children and adults.

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