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.
  • Medicaid Premiums and Cost Sharing

    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.

  • NHeLP Comments to Arkansas Medicaid Rules

    Leo Cuello and

    The letter contains NHeLP comments to the state of Arkansas regarding proposed rules for the Arkansas Medicaid program. The comments focus on proposed consumer notices and implementation of the alternative benefits plan (ABP).

  • Iowa Medicaid Expansion 1115 Comments

    Leo Cuello and

    These are comments to two section 1115 applications submitted by Iowa to implement Medicaid Expansion. Iowa's applications include numerous requests that are serious violations of Medicaid law, and NHeLP's comment highlights these problems and requests that HHS correct them.

  • NHeLP Comments to Arkansas 1115 Demonstration Application

    Leo Cuello and

    These are comments to Arkansas' section 1115 demonstration application (filed August 8, 2013) to implement a Medicaid Expansion using a premium assistance model. NHeLP's comments identify a number of legal problems which HHS must require Arkansas to correct prior to approving the demonstration.

  • Webinar: Medicaid Cost-Sharing

    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.

  • NHeLP Letter to Cindy Mann on Partial Medicaid Expansion

    After the Supreme Court rules that HHS could not enforce penalties on states if they refused the adult Medicaid expansion, several states showed interest in using generous federal matching funds to partially expand their adult coverage. This letter to Cindy Mann presents legal analysis supporting NHeLP's recommendation that CMS not allow states to partially expand Medicaid.

  • Limiting Cost-Sharing in Medicaid Funded Programs

    Q. My state is considering implementing cost sharing for Medicaid beneficiaries, arguing that this will save money. The state wants to implement cost sharing above the nominal amounts listed in federal Medicaid regulations and to make payment of the copayments mandatory. It also wants to impose premiums on some Medicaid populations that exceed the premium amounts currently allowed in the Medicaid laws. We understand that the state is going to ask the federal Medicaid agency for approval of these changes. Are there arguments we can make against these cuts? Can you suggest evidentiary support for our legal position?   A. Yes. A recent decision from the Ninth Circuit Court of Appeals casts doubt on the state?s plan to impose the heightened cost sharing. Moreover, numerous studies have demonstrated that Medicaid cost sharing reduces utilization of necessary services and lowers enrollment. The imposition of premiums also implicates the maintenance of efforts requirements of the Affordable Care Act.   Discussion   Medicaid cost sharing rules Cost sharing requires a patient to pay part of the cost of health care services, such as enrollment fees, premiums, deductibles, coinsurance, copayments, or similar charges. Congress has been very…

  • Medicaid HCBS and 1115 Waivers

    For full publication text, download document.

  • CMS Issues Guidance on MOE under ARRA

    This fact sheet describes CMS guidance regarding Section 5001 of the American Recovery and Reinvestment Act of 2009. Section 5001 offers states temporary increases in their federal medical assistance percentage (FMAP) between October 1, 2008 and December 31, 2010. The CMS guidance addresses increased FMAP methodology and grant issuance; reinstatement processes when states reverse disqualifying policies; frequently asked questions from states; and Section 5001?s maintenance of effort (MOE) provision.

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