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 David Machledt in Waivers and Demonstrations.
  • March 4, 2015

    Q&A: Health Expense Accounts in Medicaid

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    In considering whether to accept federal funds for the Affordable Care Act's (ACA) adult Medicaid expansion, several states have turned to approaches that establish individual accounts for beneficiaries to manage their Medicaid expenses. The Healthy Indiana Plan (HIP), implemented in 2008 and renewed with changes in 2015, was the first demonstration to deploy such a model. Designed very loosely after Health Savings Accounts, HIP remains the only Medicaid program that couples a health expenses account with a high deductible insurance plan. CMS has approved two substantially different health expense account demonstrations in Michigan and Arkansas. All these models are closely tied to the imposition of premiums and, in some cases, higher cost sharing on beneficiaries. This Q & A reviews the differences between these models, explores the legal requirements that apply to Medicaid health expense accounts and explains some of the policy ramifications of this approach to Medicaid expansion. A summary of key takeaways from this report is also available.

  • October 27, 2014

    NHeLP Comments on Amendments to Arkansas’s Health Care Independence Program

    Arkansas recently proposed amendments to its premium assistance Medicaid expansion demonstration, the Health Care Independence Program. These are NHeLP's comments to the proposed amendments, which include new premium and cost sharing provisions, limitations to nonemergency medical transportation, and a health care expenses account for premium assistance enrollees.

  • March 25, 2014

    Medicaid Premiums and Cost Sharing

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    This brief reviews the literature on the impact of premiums and cost sharing on enrollment, service utilization, and health status. It focuses particularly on how the research consensus fits with the flexibility Medicaid law gives states to establish premiums and cost sharing. It also highlights changes brought about by new cost sharing regulations and discusses the legal and policy ramifications of proposals by some states to charge Medicaid beneficiaries even higher cost sharing and premiums.

  • August 29, 2013

    Webinar: Medicaid Cost-Sharing

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    National Health Law Program Legal Director Jane Perkins and Senior Policy Analyst David Machledt discuss cost-sharing, the portions of medical bills that are payed by the enrollee, and premiums in the context of Medicaid. This webinar covers the relative impacts of cost-sharing and premiums on access to care at different income levels, the legal requirements that limit Medicaid cost-sharing, the important litigation on Medicaid cost-sharing at the time of recording (including Section 1115 Demonstration cases), and tips for advocates working in this policy area. Download the slides from this presentation here. Note: This is Part II of our two-part series on Medicaid Eligibility Regulations. View Part I, "Medicaid Alternative Benefits Plans," here.

  • July 23, 2013

    Q&A – Early MAGI Implementation

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    To help facilitate the transition to MAGI, CMS recently issued guidance allowing states to implement MAGI on October 1, 2013, coinciding with the beginning of open enrollment in the new health insurance marketplaces (exchanges).The following Q & A addresses questions and concerns regarding the early implementation of MAGI, including how to best protect current enrollees.

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