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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- 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.
- April 10, 2018
In comments to the U.S. Department of Health & Human Services (HHS), the National Health Law Program urges the Secretary to reject New Mexico's Sec. 1115 Medicaid waiver project, so-called "Centennial Care." While it includes several true experimental pilots, such as a pilot to improve access to long-acting reversible contraceptives for women and another to provide in-home prenatal and postpartum care, the application also proposes numerous waivers likely to impede access to coverage and care for low-income New Mexicans. These provisions do not promote the objectives of the Medicaid program and should not be approved, including new premiums with disenrollment and lockouts for nonpayment, high co-payments for non-emergency use of the Emergency Department, termination of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for 19-20 year olds, thinner benefit packages for parents and caretakers, limited family planning eligibility, termination of Transitional Medical Assistance for low-income parents, and a phase out of retroactive eligibility. Finally, while the proposal includes increased funding for treatment of substance use disorders and mental health conditions, the National Health Law Program argues that the resources should be focused on proven, community-based treatments supported by available evidence, rather than institutional care.
- March 8, 2018
The "Arkansas Works," Medicaid waiver project approved by Trump's HHS, if implemented, will block thousands of low-income people living with disabilities in Arkansas from accessing Medicaid. National Health Law Program Senior Policy Analyst David Machledt explains how Arkansas's waiver scheme, which provides no "resources or initiatives for employment supports that facilitate work," will add to the obstacles that people living with disabilities face in accessing health care in Arkansas. "People with disabilities," Machledt writes, "will be among those most negatively affected by administrative snafus, inadequate notice, insufficient accommodations, and not enough employment supports to meet their needs."
- March 6, 2018
On March 5, 2018 HHS approved a section 1115 waiver requested by Arkansas. The approved project is effectively a cut that will worsen or eliminate access to Medicaid for low-income individuals. This proposal will have a significant detrimental impact on people with disabilities. This fact sheet describes that impact.
- March 6, 2018
Trump's HHS is pushing states like Arkansas to alter their Medicaid programs in legally suspect ways, such as adding work requirement programs in order for low-income individuals and families to access health care. The Arkansas waiver project also locks people out if they are unable to document in specific ways their efforts to find and keep work. National Health Law Program Senior Policy Analyst David Machledt, writes in this fact sheet, that the Arkansas waiver scheme adds "a bundle of red-tape mandates," but fails to provide "no added resources to create new employment opportunities or increase support for job training, education, or affordable childcare."
- February 3, 2018
President Trump's HHS on Feb. 2 approved an extension of Indiana's controversial Medicaid waiver project, which includes even more onerous obstacles to access Medicaid in the state. NHeLP Senior Policy Analyst David Machledt examines the Ind. waiver project, and notes "Indiana's own estimates are that this policy will lead to 25,000 Hoosiers losing coverage when fully implemented." Machledt continues that other parts of the Ind. waiver scheme will subject some low-income individuals and families to waiting periods of up to two months, which will mean a "matter of life-or-death for many of these" Hoosiers.
- February 1, 2018
Earlier today, HHS approved a section 1115 waiver requested by Indiana. The approved project is effectively a cut that will worsen or eliminate access to Medicaid for low-income individuals. This proposal will have a significant detrimental impact on people with disabilities. Though Indiana sells its proposal as primarily affecting childless, unemployed adults, many of the approved provisions will impact everyone in the expansion group, including people with disabilities. This fact sheet describes that impact.
- January 12, 2018
Earlier today, HHS approved a section 1115 waiver requested by Kentucky. The approved project is effectively a cut that will worsen or eliminate access to Medicaid for low-income individuals. This proposal will have a significant detrimental impact on people with disabilities. Though Kentucky sells its proposal as primarily affecting childless, unemployed adults, many of the approved provisions will impact everyone in the expansion group, including people with disabilities. This fact sheet describes that impact.
- February 27, 2017
Indiana expanded Medicaid through a demonstration waiver that some have lauded as a "potential model" for other states interested in expanding Medicaid. Senior Policy Analyst David Machledt, examining evaluations of Indiana's so-called Healthy Indiana Program, concludes that the state's Medicaid demonstration, so far, has generated plenty of confusion, but little evidence that it has improved access to health care services or produced healthy behaviors. (Updated May, 2019)
- March 4, 2015
States reluctant to accept federal funds for the Affordable Care Act's adult Medicaid expansion have proposed health expense accounts as a mechanism to "brand" their expansion as different. These accounts add administrative complexity, cost, and likely impede beneficiaries' access to care. The Healthy Indiana Plan (HIP), implemented in 2008 and renewed with changes in 2015, was the first demonstration to deploy such a model. CMS has also approved different health expense accounts in Michigan and Arkansas. All these models, approved using the demonstration authority in § 1115 of the Social Security Act, include premiums and, in some cases, higher cost sharing on beneficiaries. This fact sheet provides a brief overview and highlights some of the key ramifications of this approach to Medicaid expansion. For a fuller discussion of health expense accounts, see NHeLP's Q & A on Health Expense Accounts in Medicaid.