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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- July 7, 2020
Letter Calls on Seema Verma to Reject Oklahoma’s Section 1115 Request Following Ballot Initiative
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
Letter Calls on Seema Verma to Reject Oklahoma’s Section 1115 Request as Incomplete
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.
- December 23, 2019
Letter to CMS Requesting Extension for TennCare II Demonstration Comment Period
On Monday, December 23, 2019, the National Health Law Program sent a letter to CMS Administrator Seema Verma asking her to extend the public comment period for Tennessee’s section 1115 waiver application that seeks to transform the State’s Medicaid program into a block grant. The CMS comment site is blocking and/or deterring submission of comments from the public—a problem first detected over the weekend.
- November 26, 2019
Letter to CMS Concerning TennCare II Demonstration
In a letter to administrator Seema Verma, the National Health Law Program has asked CMS to return Tennessee’s recently submitted section 1115 application to the State. Tennessee says the proposal would create a block grant. However, the NHeLP letter says the proposal is so short on specifics and is vague to the point where the public will not be able to meaningfully review and comment on it.
- April 8, 2019
Webinar: Judge Vacates HHS Approvals of Medicaid Work Requirements in Kentucky & Arkansas
In a recent webinar, National Health Law Program Legal Director Jane Perkins and Senior Attorneys Catherine McKee and Elizabeth Edwards discussed the recent federal court decisions blocking work requirements and other coverage restrictions in the Kentucky and Arkansas Medicaid programs. They discussed the cases as well as key takeaways and unanswered questions. The National Health Law Program, along with national and state partners, challenged the HHS approval of Medicaid work requirements in Stewart v. Azar and Gresham v. Azar. Download the webinar below.
- October 26, 2018
Comments to HHS on Michigan 1115 Waiver Project
In comments to the U.S. Department of Health and Human Services, the National Health Law Program urges the department to reject Michigan’s Sec. 1115 Medicaid waiver application, because it would increase premiums and impose unlawful conditions of eligibility, including required healthy behavior and work-related activities. In previous comments to HHS, the National Health Law Program has detailed why even the existing premiums and cost sharing structure decrease enrollment and access to care and should not have been approved. Subsequent evidence has shown that the existing premiums and healthy behavior policies are increasing medical debt and depressing enrollment. The proposed changes will only exacerbate these problems. Additionally, the proposed changes do not comply with § 1115 of the Social Security Act, as they will block, rather than facilitate, access to Medicaid coverage.
- August 18, 2018
National Health Law Program: Comments to HHS on KY Sec. 1115 Waiver Project
National Health Law Program in comments to the U.S. Department of Health and Human Services, again, urged the agency to reject Kentucky's proposed Medicaid waiver plan that was invalidated by a U.S. District Court in Stewart v. Azar. The Kentucky plan is again before HHS because the district court remanded it to the agency with direction to re-consider, within the bounds of Medicaid law, the legality of Kentucky's proposed plan. National Health Law Program again argues that the Kentucky waiver plan will lead to substantial numbers of individuals and families losing health care coverage, with many of them unable to meet the onerous requirements of Kentucky's work requirement. The work requirement's attempt at exempting "medically frail" individuals, data shows, will not do so adequately leaving many individuals with disabilities "more likely to lose benefits."
- July 6, 2018
Groups Urge CMS Action on Kentucky’s Cuts to Medicaid Services
Centers for Medicare & Medicaid Services (CMS) should reject the Kentucky governor's "Alternative Benefit Plan (ABP) State Plan Amendment (SPA)," which took effect on July 1, according to the National Health Law Program, Kentucky Equal Justice Center and the Southern Poverty Law Center in a July 6 letter sent to Acting Director of CMS Timothy Hill. The groups are representing Kentuckians in a federal lawsuit challenging HHS's approval of Kentucky's Section 1115 waiver plan, which includes onerous restrictions on Medicaid services. On June 29, a federal court vacated and remanded the Kentucky waiver plan to the U.S. Department of Health and Human Services. In their July 6 letter to CMS, the groups argue that the Kentucky governor's application to cut vision, dental, and non-emergency medical transportation services is procedurally flawed, and therefore CMS must reject it and reverse the cuts to Medicaid services in Kentucky.
- June 13, 2018
Fast Facts: Stewart v. Azar Oral Argument
What you need to know about June 15 oral argument in the federal class action lawsuit from Kentuckians challenging the Trump administration's approval of an onerous Medicaid waiver scheme that includes burdensome work requirements, high premiums, lock outs, and elimination of retroactive health care coverage. Read National Health Law Program's guide on what to expect from oral argument by Mara Youdelman and Jane Perkins.
- May 22, 2018
National Health Law Program Urges HHS to Reject Arizona’s Retroactive Waiver
National Health Law Program urges the U.S. Department of Health and Human Services Secretary to reject a Sec. 1115 Medicaid waiver proposal from Arizona that would end retroactive health care cover for thousands of low-income individuals and families in the state. The purpose of the Medicaid Act's retroactive coverage is to protect "persons who are eligible for Medicaid but do not apply for assistance until after they have received care, either because they did not know about the Medicaid eligibility requirements, or because the sudden nature of their illness prevented their applying." In comments to HHS, the National Health Law Program says, "Waiving retroactive coverage will harm low-income people and care providers. Without this protection, individuals are likely to incur significant medical costs if they need medical care and are not yet enrolled in coverage."