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.
  • September 11, 2024

    Commenting on § 1915(c) HCBS Waivers: A Guide for Common Issues

    Medicaid home and community-based (HCBS) § 1915(c) waivers provide critical services for people with disabilities across the country. These waivers change because states often submit amendments to these waivers and the waivers also have to be renewed every few years. Each time a waiver is renewed or amended, states must put the waiver out for public comment. The comment period is an excellent opportunity to provide input on the requested changes and also tell the state about the impact of those changes or other issues with the waiver. Although a waiver document may seem long and potentially intimidating, this guide is intended to provide a roadmap for how to look for and craft comments on common issues.

  • August 28, 2024

    Medicaid Advisory Committees: Best Practices for Effective Stakeholder Engagement

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    Although Medical Care Advisory Committees (MCACs) have been federally required for nearly forty years, some states have seriously underutilized this opportunity to monitor and improve their Medicaid programs. In May 2024, the Centers for Medicare & Medicaid Services (CMS) updated regulations implementing MCACs. New requirements for the renamed Medicaid Advisory Committees (MACs) and Beneficiary Advisory Councils (BACs) present an important opportunity to enhance the role of Medicaid enrollees and other stakeholders in state Medicaid policy development and oversight. This paper describes key regulatory changes for MACs and BACs, as well as operational challenges and best practices to help ensure meaningful stakeholder engagement

  • July 18, 2024

    Q&A on Federal Authorities to Extend Pregnancy Medicaid Coverage

    As the largest payer of pregnancy related care in the U.S. and payer for 65% of Black pregnant peoples’ labor and delivery care nationwide, Medicaid has a strong influence on maternal health outcomes and equity. This issue brief answers the following questions: Q.1 What are the Medicaid Act’s minimum requirements for pregnancy Medicaid coverage? Q.2 How can states provide pregnancy Medicaid coverage beyond the Medicaid Act’s minimum? Q.3 Do § 1115 waivers to extend pregnancy Medicaid coverage meet statutory requirements? Q.4 What are the reproductive health equity implications of these § 1115 waiver proposals? Q.5 How has CMS responded to state proposals to restrict post-pregnancy coverage extensions by duration or pregnancy outcome?

  • 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.

  • January 29, 2024

    HHS’s 2024 Final Rule on Health Care Refusals: What Health Advocates Need to Know

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    Federal health care refusal laws, such as the Weldon Amendment and the Church Amendments, govern when and how covered health care entities, providers, and professionals can refuse to deliver or provide information to patients on medically necessary health care that they find objectionable on the basis of their religious or personal beliefs. This issue brief provides an overview of the U.S. Department of Health and Human Services (HHS) Office for Civil Rights' (OCR) 2024 final rule, “Safeguarding the Rights of Conscience as Protected by Federal Statutes," which rescinds the most harmful components of the Trump Administration’s unlawful, unethical, and discriminatory 2019 health care refusal regulations.

  • 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.

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