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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- 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
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.
- August 18, 2021
Comments on Maryland Section 1115 Request to Waive the IMD Exclusion for Mental Health
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Maryland’s request to waive the Institutions for Mental Diseases (IMD) exclusion for certain private psychiatric facilities.
- April 27, 2021
Alabama Section 1115 Institutions for Mental Disease Waiver for Serious Mental Illness Comments
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Alabama’s proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. First, the Secretary may only waive requirements of the federal Medicaid Act to conduct an experiment or test a novel approach to improve medical assistance for low-income individuals, and Alabama has not proposed a genuine experiment or novel approach. Second, Alabama asks the Secretary to waive provisions of the Medicaid Act the Secretary does not have the authority to waive. Section 1115 only permits the waiver of those requirements found in 42 U.S.C. § 1396a, and Alabama requests a waiver of provisions outside of 42 U.S.C. § 1396a, including the “Institution for Mental Diseases” (IMD) exclusion. Third, Alabama’s proposal risks diverting funds away from community-based services, undermining decades of progress toward increased community integration. Last, Alabama proposes several reforms that simply do not require any wavier of the Medicaid Act. Such reforms should be pursued outside of the context of a waiver.
- February 16, 2021
Comments on Utah 1115 Primary Care Network Demonstration Waiver Amendment Request: In Vitro Fertilization and Genetic Testing for Qualified Conditions
In comments to the Department of Health and Human Services, the National Health Law Program asks HHS to reject Utah's proposal to restrict coverage of in vitro fertilization (IVF) services and preimplantation genetic diagnosis (PGD) for Medicaid-enrolled individuals who: (1) have been diagnosed by a physician as having a genetic trait associated with one of five specified conditions; and (2) intend to get pregnant with a partner who also has been diagnosed by a physician as having a genetic trait associated with the same condition. First, Utah's application does not contain a sufficient level of detail to allow for meaningful comment. Second, Utah’s proposal is not likely to assist in promoting the objectives of the Medicaid Act and does not propose an actual experiment. And finally, Utah’s proposal is at best arbitrary, and at worst motivated by the discriminatory motive of trying to avoid providing medical assistance to people with disabilities.
- October 7, 2020
NHeLP Comments on MassHealth SMI-SED Supplemental Application Waiver
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Massachusetts' proposed request to waiver to obtain federal finanical participation for services provided in Institutions for Mental Diseases (IMD). HHS should reject Massachusett's application because Massachusetts did not provide adequate state-level notice and opportunity to comment prior to submitting this amendment. Further, HHS does not have authority to grant the request to waive the IMD exclusion because Massachusetts has not proposed a genuine experiment, and the Secretary may only waive requirements of the federal Medicaid Act to conduct an experiment or test a novel approach to improve medical assistance for low-income individuals. Furthermore, Section 1115 only permits waiver of those requirements found in 42 U.S.C. § 1396a, and the IMD exclusion lies outside of 42 U.S.C. § 1396a. Last, the proposal risks diverting funds away from appropriate community-based services, undermining decades of progress towards increased community-integration.
- September 17, 2020
Utah 1115 IMD Demonstration Request Comment
Utah has applied for an 1115 demonstration waiving the IMD exclusion for people with serious mental illnesses. NHeLP submitted a comment opposing the demonstration request.
- February 7, 2020
NHeLP Comments on Idaho Behavioral Health Transformation Section 1115 Medicaid Waiver Demonstration Application
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Idaho's proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. HHS does not have authority to grant the request to waive the IMD exclusion because Idaho has not proposed a genuine experiment, and the Secretary may only waive requirements of the federal Medicaid Act to conduct an experiment or test a novel approach to improve medical assistance for low-income individuals. Furthermore, Section 1115 only permits waiver of those requirements found in 42 U.S.C. § 1396a, and the IMD exclusion lies outside of 42 U.S.C. § 1396a. Last, the proposal risks diverting funds away from appropriate community-based services, undermining decades of progress towards increased community-integration.
- October 16, 2019
NHeLP comments on Indiana’s Serious Mental Illness/Serious Emotional Disturbance Section 1115 Waiver Request
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Indiana’s proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. HHS, however, does not have authority to grant the request to waive the IMD exclusion because Indiana has not proposed a genuine experiment, and the Secretary may only waive requirements of the federal Medicaid Act to conduct an experiment or test a novel approach to improve medical assistance for low-income individuals. Furthermore, Section 1115 only permits waiver of those requirements found in 42 U.S.C. § 1396a, and the IMD exclusion lies outside of 42 U.S.C. § 1396a. Last, the proposal risks diverting funds away from appropriate community-based services, undermining decades of progress towards increased community-integration.
