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 Jennifer Lav in Waivers and Demonstrations.
  • 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 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 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.

  • November 21, 2022

    NHeLP comments on New Hampshire SUD/SMI/SED Treatment and Recovery Access Demonstration Extension Request

    In comments to the Department of Health and Human Services, the National Health Law Program asks the Secretary to reject New Hampshire's request to waive the IMD exclusion. We further urges HHS to reject the request to obtain federal funding for children that are in IMDs. Last, to the extent that HHS allows New Hampshire to obtain federal funding for reentry services, we ask that HHS consider including the guardrails and limitations suggested in these comments.

  • October 5, 2022

    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.

  • September 16, 2022

    Washington Medicaid Transformation Project Demonstration Extension Request

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    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.

  • September 7, 2022

    Washington Medicaid Transformation Project Demonstration Extension Request

    and

    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.

  • June 7, 2022

    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.

  • November 1, 2021

    Comments: Utah Primary Care Network Extension Request

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    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

    Comments: New Hampshire Section 1115 Demonstration Amendment Request

    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.

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