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 Jane Perkins in Waivers and Demonstrations.
  • July 5, 2017

    Sec. 1115 Demonstration Authority: Medicaid Provisions That Prohibit a Waiver

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    With HHS Secretary Tom Price open to Section 1115 waivers in Medicaid that could create obstacles to accessing Medicaid services, National Health Law Program's N.C. office has created a primer on what parts of the Medicaid act that cannot be waived. As this paper notes, "Section 1115 of the Social Security Act (SSA) provides the Secretary of Health and Human Services with limited authority to waive requirements of the Medicaid Act."

  • April 29, 2017

    Quick Review: Transparency, Opportunity for Comment

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    A Quick Review of transparency and opportunity for public comment in requests for Section 1115 Waivers. In this brief overview, Senior Attorney Catherine McKee, Legal Director Jane Perkins, and Managing Attorney of the DC office Mara Youdelman note, "The importance of the transparency and public accountability requirements has never been greater," as the HHS secretary has expressed a willingness to approve demonstrations that include work requirements, eliminate presumptive eligibility, and impose greater premiums and cost-sharing than the Medicaid Act allows.

  • April 21, 2017

    Sec. 1115 Waiver Requests: Transparency & Opportunity for Public Comment

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    With HHS Secretary Tom Price open to Section 1115 waivers in Medicaid that could include work requirements,  state health advocates must be vigilant in ensuring waivers do not contravene Medicaid law. The Affordable Care Act (ACA) amended Sec. 1115 to require greater transparency and opportunity for public comment on proposed demonstration waivers considered by states and the Centers for Medicare & Medicaid Services (CMS). In this Issue Brief, Senior Attorney Catherine McKee and Legal Director Jane Perkins provide an in-depth look at the process for application, for approving Sec. 1115 waivers, requirements for monitoring approved waivers, and highlight steps advocates should take "to ensure that states and CMS consider the proposal's potential effects on Medicaid enrollees."

  • April 4, 2017

    Waivers of Medicaid Requirements – A Quick Review

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    In a companion piece to Background to Medicaid and Section 1115 of the Social Security Act, Legal Director Jane Perkins and Managing Attorney of the DC office Mara Youdelman provide a brief review of how certain Medicaid requirements may be waived. They conclude, in part, that "Section 1115 of the Social Security Act gives the Secretary of HHS limited authority to approve Medicaid waivers."

  • April 3, 2017

    Background to Medicaid and Section 1115 of the Social Security Act

    Health and Human Services (HHS) Secretary Tom Price has signaled a willingness to allow states to reshape their Medicaid programs. In this issue brief, Legal Director Jane Perkins provides a background to Medicaid and Section 1115 of the Social Security Act to explain what HHS and the states are permitted to do in regards to providing Medicaid services. Perkins concludes that Section 1115 "allows states to test novel approaches to providing medical assistance," but does not allow HHS or the states to "ignore congressional mandates; to cut eligibility, services, or provider payments; or to use section 1115 to save money."

  • March 21, 2017

    Medicaid Work Requirements – Legally Suspect

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    Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why adding a work requirement to Medicaid is "legally suspect." They explain that currently the Medicaid Act has four requirements that an individual must meet that do not include a mandatory work requirement. "A number of courts," Perkins and McDonald write, "have recognized that states may not 'add additional requirements for Medicaid eligibility' that are not set forth in the Medicaid Act." They also note that the purpose of Medicaid is to "furnish medical assistance to low-income individuals who cannot afford the costs of medically necessary services and to furnish 'rehabilitation and other services to help attain or retain capability for independence or self-care. A mandatory work requirement is not medical assistance; it is not a service provided to Medicaid beneficiaries."

  • March 21, 2017

    Medicaid Work Requirements – Not a Healthy Choice

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    In an effort to win conservative members' support for the Affordable Care Care Act repeal bill, House Republicans have added a work requirement for Medicaid to the measure. In this issue brief, NHeLP Managing Attorney of the DC office Mara Youdelman,  Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why such work requirements "run counter to the purpose of Medicaid." They conclude, "Work requirements would stand Medicaid's purpose on its head by creating barriers to coverage and the pathway to health that the coverage represents."

  • 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.

  • January 14, 2015

    Health Advocate: Our New Year’s Resolutions

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    This edition of the Health Advocate previews what is ahead in the coming months including the continuing theme of Medicaid expansion, protecting what makes Medicaid "Medicaid" as the new Congress gears up, and our work to protect and expand access to reproductive health and the courts.

  • September 24, 2014

    NHeLP Comments to Healthy Indiana Plan Renewal and Healthy Indiana Plan 2.0 Section 1115 Demonstration Applications

    Leo Cuello and

    Comments to HHS regarding Indiana's HIP and HIP 2.0 section 1115 demonstrations to implement the Medicaid expansion. NHeLP's comments focus on the need to implement Medicaid expansion without waivers that eliminate core Medicaid protections.

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