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 by Héctor Hernández-Delgado in Waivers and Demonstrations.
  • December 22, 2022

    An Advocate’s Guide to Medi-Cal Services

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    The National Health Law Program is pleased to present our updated 2022 Advocates Guide to Medi-Cal Services. NHeLP's Medi-Cal Services Guide, first released in 2020, provides an in-depth description of some of the most important services covered in the Medi-Cal program, including prescription drug services, mental health and substance use disorder services, reproductive and sexual health services, gender-affirming services, dental services, children services, among others.  The 2022 updated guide focuses on key changes the Medi-Cal program has undergone in recent years. In particular, relevant chapters now emphasize policy changes implemented pursuant to the California Advancing and Innovating Medi-Cal (CalAIM) initiative, including a new chapter on Case Management and Community-Support Services, which provides insight on new services that have become widely available through implementation of CalAIM. There is also a new addendum summarizing Medi-Cal's telehealth policy in light of changes adopted during the COVID-19 pandemic.  The entire guide can be downloaded or individual chapters accessed below.

  • May 5, 2022

    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.

  • November 5, 2021

    NHeLP Comments on SUPPORT Act Section 1003 Demonstration

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    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.

  • October 7, 2020

    NHeLP Comments on Oklahoma Section 1115 Institutions for Mental Disease (IMD) Waiver for Serious Mental Illness/Substance Use Disorder

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    NHeLP urges the Secretary not to approve the requested waiver because 1) Oklahoma asks the Secretary to waive provisions of the Medicaid Act the Secretary does not have the authority to waive; 2) Oklahoma has not proposed a genuine experiment or novel approach; 3) Oklahoma’s proposal risks diverting funds away from community-based services, undermining decades of progress toward increased community-integration; and 4) the Secretary does not have authority to approve a Section 1115 waiver that would enable Qualified Residential Treatment Programs (QRTPs) to receive federal financial participation (FFP) for psychiatric treatment for individuals under 21 with SMI.

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