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

results by Wayne Turner in Waivers and Demonstrations.
  • NHeLP comments on Oregon’s application for renewal of the Oregon Health Plan § 1115(a) Demonstration Waiver for 2022-2027

    In public comments, NHeLP expresses support for Oregon's decision to abandon its waiver of EPSDT. However, NHeLP strongly opposes Oregon's proposal to exclude outpatient prescription drugs approved under the FDA's accelerated approval pathway. Denying Medicaid enrollees access to effective break-through therapies would harm people with serious or life-threatening medical conditions. NHeLP also expresses concern about implementation of the EPSDT waiver withdrawal, and opposes the continued use of the prioritized list for children and adults.

  • NHeLP Comments on HHS SUNSET Repeal Rule

    In the HHS SUNSET final rule, HHS sought to retroactively impose a mandatory expiration date on an estimated 18,000 duly promulgated regulations. Even long-standing rules would be automatically rescinded unless they survive a complex process of assessment and review. If implemented, programs like Medicaid and the Children’s Health Insurance Program (CHIP) would be devastated if important regulations are arbitrarily rescinded. In comments, NHeLP strongly supports the repeal of the HHS SUNSET final rule.

  • NHeLP comments on Updating Payment Parameters Rule

    In the Updating Payment Parameters Rule (UPP Rule), the Centers for Medicare & Medicaid Services proposes several important changes to enrollment in the Affordable Care Act (ACA) Marketplaces. These changes include extending the open enrollment period, establishing a year-around Special Enrollment Period for low income persons, restoring key features of the Navigator program such as providing consumers assistance in using their plans, ending the abortion double-billing provision, and restoring guard rails for Section 1332 waivers. NHeLP comments express strong support for these changes, and suggest areas where CMS can go even further to help consumers and reduce the number of insured people.

  • NHeLP Comments on HHS Regulations Rule (aka SUNSET Rule)

    In the Regulations Rule, HHS seeks to retroactively impose a mandatory expiration date on an estimated 18,000 duly promulgated regulations. Even long-standing rules would be automatically rescinded unless they survive a complex process of assessment and review. Programs like Medicaid and the Children's Health Insurance Program (CHIP) could be devastated if important regulations are arbitrarily rescinded. In comments, NHeLP pushes back against this unlawful and ill-conceived proposal designed to sabotage HHS safety net programs.

  • NHeLP comments on HHS Proposed Rule on Guidance

    Guidance documents are a valuable tool that allows agencies to clarify policy issues and explain ambiguities raised by the laws and rules they are tasked with implementing. Programs like Medicaid and the implementation of the Affordable Care Act depend heavily on guidance documents to clarify coverage requirements and the obligations of state programs serving low income communities. However, a HHS proposed “good guidance " rule would open the door to the administration repealing important guidance without notice or explanation, and would create a time-consuming and burdensome process to reinstate or implement new guidance. In these comments, NHeLP explains why the proposed "good guidance" rule would be, in fact, harmful, and urge HHS to withdraw the proposed rule.

  • Q&A – Early MAGI Implementation

    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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