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 in Waivers and Demonstrations.
  • May 7, 2024

    NHeLP Comments on “Healthy Texas Women” Sec. 1115 Waiver Project Extension Request

    In comments to the U.S. Department of Health and Human Services, NHeLP urges the department to reject Texas’ request to continue waiving freedom of choice in its so-called “Healthy Texas Women” Medicaid demonstration waiver. The comments note that HHS “may only approve an application that proposes an experiment, pilot, or demonstration that is likely to promote the objectives of the Medicaid Act.” Texas’ request to continue waiving freedom of choice protections would not promote the objectives of the Medicaid Act. Instead, continuing to do so will make it increasingly difficult for low-income women to access family planning and other preventive services.

  • April 1, 2024

    Comments on Arkansas IMD and Reentry Demonstration Proposal

    In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Arkansas’ request to obtain federal financial participation (FFP) for expenditures for Medicaid services in institutions for mental disease (IMDs) and in prisons, jails, and youth correctional facilities.

  • February 2, 2024

    Case Update: Supplemental Complaint file in Rose v. Becerra

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    This case update focuses on Rose v. Becerra, which challenges approval of a Section 1115 Medicaid project in Indiana. CMS has recently reapproved the project, which allows Indiana to continue imposing premiums on very low-income people and to waive retroactive coverage and non-emergency medical transportation. This case update provides background and explains events leading up to filing the Supplemental Complaint.

  • November 29, 2023

    NHeLP Federal Comments on California CalAIM 1115 Waiver Amendment Submission

    Abbi Coursolle

    In comments to HHS, NHeLP provides several policy considerations regarding California's proposals to add Transitional Rent as an "In Lieu of Service" that Medi-Cal managed care plans could offer to enrollees.

  • November 29, 2023

    NHeLP Federal Comments on California BH-Connect 1115 Waiver Submission

    Abbi Coursolle

    In comments to HHS, NHeLP urges the Secretary to reject California’s Section 1115 demonstration extension request to waive 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 mental health conditions and 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, NHeLP provides several policy considerations regarding California's proposals to efforts to building out a comprehensive continuum of care for beneficiaries with significant behavioral health needs.

  • May 30, 2023

    Trends in State Medicaid Continuous Coverage Unwinding Plans

    As part of the Medicaid continuous coverage unwinding, states were required to create plans to describe how they will redetermine the eligibility of all Medicaid enrollees. This paper identifies some of the major trends affecting beneficiaries in available unwinding plans including choices that may affect coverage loss and ease of beneficiaries in completing redeterminations. Although there are many choices states may make in unwinding and not all of those choices may be reflected in a state's plan, this paper focuses on trends most likely to impact coverage.

  • April 17, 2023

    What Makes Medicaid, Medicaid?

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    With the passage of the Affordable Care Act (ACA) in 2010, and the implementation of Medicaid expansions and Marketplaces in 2014, the U.S. significantly expanded access to health insurance coverage. Architects of the ACA rightly viewed Medicaid as an essential piece of the universal coverage puzzle. Indeed, Medicaid is a special piece of the coverage pie. This paper explains why it is essential for health coverage in the U.S. to maintain what makes Medicaid, Medicaid. For additional information about unique and important aspects of the Medicaid program, check out our entire What Makes Medicaid, Medicaid? series. And for a high-level overview of this paper, see our Highlights: What Makes Medicaid, Medicaid? factsheet. This series was originally published in 2015 and an archival copy can be found here.

  • February 21, 2023

    Comments on Utah’s Long Term Services and Supports for Behaviorally Complex Individuals Demonstration Amendment Request

    In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Utah's request to fund services in nursing facilities for people with "behaviorally complex conditions."

  • 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.

  • February 6, 2023

    NHeLP Comments on New York State Medicaid Section 1115 Demonstration Amendment

    In these comments, NHeLP urges HHS to reject New York’s request for federal financial participation for institutions for mental disease, as increasing federal funding for institutional care risks serious harm to individuals with disabilities.

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