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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- May 5, 2022
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.
- April 14, 2022
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.
- January 27, 2022
NHeLP submitted comments during the reopened comment period regarding Georgia's Section 1332 State Innovation Waiver. NHeLP recommends that HHS withdraw its approval of this waiver because it would impose a number of unlawful conditions on coverage and access to care for the marketplace and Medicaid populations.
- January 6, 2022
In 2017, the Centers for Medicare & Medicaid Services issued a policy announcing its intent to “approve the extension of routine, successful, non-complex” section 1115 waivers for a period of up to 10 years. Thereafter, CMS extended a number of projects for 10 years. This issue brief explains how the policy and the subsequent approvals are contrary to section 1115 and calls on the Biden administration to rescind the policy, reconsider the approvals, and adhere to the text of section 1115 moving forward.
- 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.
- November 30, 2021
Comments from the National Health Law Program opposing Montana's request for federal funding of mental health and SUD services in IMDs.
- November 11, 2021
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.
- November 5, 2021
The Substance Use Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act requires the Department of Health and Human Services (HHS) to conduct a demonstration to increase the capacity of Medicaid providers to deliver substance use disorder (SUD) services. In comments to HHS, NHeLP urges the administration to ensure the demonstration centers beneficiaries in addition to providers; emphasizes availability or lack thereof of community-based services; surveys the harms of utilization management limitations on access to treatment for SUD; and evaluate compliance with EPSDT requirements. Finally, NHeLP calls on HHS to evaluate the impact of the projects on reducing health disparities.
- November 1, 2021
In comments to the Department of Health and Human Services, the National Health Law Program explains that the initial purpose of the Primary Care Network project, which started nearly 20 years ago as a way to expand coverage to population groups that were not described in the Medicaid Act at that time, has been lost. Currently, the project is a hodgepodge of features, many of which restrict coverage and access to care. As a result, we recommend that CMS take the following steps in response to Utah’s application: Where possible, CMS should require Utah to implement elements of the project through other authorities (the state plan or non-demonstration waiver authorities). CMS should then evaluate the remaining elements of the project in accordance with section 1115.
- November 1, 2021
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject New Hampshire's request to waive the Institutions for Mental Diseases (IMD) exclusion for certain psychiatric facilities.