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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- January 6, 2022
In 2017, the Centers for Medicare & Medicaid Services issued a policy announcing its intent to “approve the extension of routine, successful, non-complex” section 1115 waivers for a period of up to 10 years. Thereafter, CMS extended a number of projects for 10 years. This issue brief explains how the policy and the subsequent approvals are contrary to section 1115 and calls on the Biden administration to rescind the policy, reconsider the approvals, and adhere to the text of section 1115 moving forward.
- 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.
- November 1, 2021
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.
- July 15, 2021
In 2020, the COVID-19 pandemic plunged the United States into a public health crisis. This situation was not entirely unprecedented. Local crises had previously been triggered by events such as hurricanes (e.g., Katrina in 2005, Irma in 2017), wildfires (e.g., California in 2017 and 2018), lead contamination (Flint, Michigan in 2016), and terrorist attacks (New York City after 9/11). During these events, the Secretary of the Department of Health and Human Services (HHS) used waiver authority to allow affected states to ignore otherwise mandatory Medicaid requirements so that they could use Medicaid as part of the emergency response. These crises, and particularly the COVID-19 pandemic, have made it clear that the current statutes do not give HHS sufficient emergency waiver authority. This paper: Outlines legal authorities that allow HHS and states to adjust their Medicaid programs during an emergency; Identifies deficiencies in these authorities; and Makes recommendations that, if implemented, will better prepare Medicaid programs for the next crisis. The two authorities that HHS and states have turned to the most during emergencies are Section 1115 and Section 1135 of the Social Security Act.
- June 16, 2021
Tension and confusion can arise over how HHS allows states to change their Medicaid programs, whether through a state plan amendment (SPA) or a Section 1115 project. To help guard against the improper use of Section 1115 waivers, advocates must know the distinctions between Section 1115 waivers and SPAs. This primer outlines these distinctions.
- May 20, 2021
Tension and confusion can arise over how HHS allows states to change their Medicaid programs, whether through a state plan amendment (SPA) or a Section 1115 project. To help guard against the impoper use of Section 1115 waivers, advocates must know the distinctions between Section 1115 waivers and SPAs. This primer outlines these distinctions.
- July 24, 2020
In comments to the Department of Health and Human Services, the National Health Law Program asks HHS to reject Oklahoma's proposed project, which would impose a number of unlawful conditions on coverage and access to care. Oklahoma also requested permission to shift to per capita cap funding for the Medicaid expansion population.
- July 20, 2020
This publication identifies ten actions that advocates can take to maximize eligibility and enrollment in Medicaid during and after the COVID-19 emergency.
- July 7, 2020
In a letter to the Center on Medicare & Medicaid Services, the National Health Law Program requested that Administrator Verma reject Oklahoma's SoonerCare 2.0 application. The proposed 1115 waiver project would violate recent changes to Oklahoma law following the June 30, 2020 ballot initiative that amended the Oklahoma Constitution to require the state to expand Medicaid. The ballot initiative included several protections for the expansion population, which would conflict with the SoonerCare2.0 proposal.
- April 23, 2020
In an April 23rd letter to Seema Verma, the Administrator of the Centers for Medicare & Medicaid Services, the National Health Law Program asked the Administrator to withhold issuing a letter of completeness for Oklahoma's Section 1115 SoonerCare 2.0 application. A letter of completeness would trigger federal review of the project. As proposed, SoonerCare 2.0 would impose coverage restrictions, including work requirements, and transform Medicaid from entitlement to per capita funding. On March 17, 2020, the National Health Law Program wrote to Administrator Verma asking her to require the State to postpone the public comment process for this application due to the COVID-19 emergency. The State did not do that, and instead held four "virtual" meetings. As explained in the letter, these meetings failed to satisfy the State’s public comment obligations under Section 1115 and CMS’s implementing regulations and disproportionately excluded the low-income individuals most likely affected by the project.