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 in Waivers and Demonstrations.
  • MAGI, Streamlined Applications, and Medicaid Family Planning Expansions

    Erin Armstrong, External Source, and

    The Affordable Care Act (ACA) requires states implement a uniform methodology for determining income - modified adjusted gross income (MAGI) - in their eligibility determinations for Medicaid and for premium subsidies in the health insurance marketplaces. The ACA also requires states to move to a single, streamlined application (SSA), which the federal and state insurance marketplaces use to gather and assess information necessary to determine the insurance coverage and assistance for which a person is eligible. Consumer and provider groups have expressed concern about the impact of transitioning to MAGI and SSA on Medicaid family planning expansion programs. In recent months, representatives of NHeLP, NFPRHA, the Guttmacher Institute, NWLC, and PPFA met with representatives of the Centers for Medicare & Medicaid Services (CMS) to discuss these issues. This memo details the outcomes of those conversations with CMS regarding MAGI, SSA, and Medicaid family planning expansions.

  • Earlier Access to Care for Uninsured Women Living with HIV and the ACA

    The Medicaid program has traditionally served as an important safety-net program for low-income women living with HIV/AIDS; however, the categorical requirements for Medicaid have excluded many individuals from coverage. The Affordable Care Act, through the Medicaid Expansion, presents the opportunity for previously ineligible low-income women living with HIV to become eligible for Medicaid. Also, states have previously used §1115 demonstration projects to provide innovative approaches to care for this community. This analysis reviews how § 1115 demonstrations can effectively be used to develop innovative models of reducing transmission, provide early treatment, and reduce long-term disabilities for WLWH who currently reside in states not expanding Medicaid eligibility.

  • Health Advocate: Our New Year’s Resolutions

    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.

  • What Makes Medicaid, Medicaid

    With the passage of the Affordable Care Act (ACA) in 2010, and the implementation of Medicaid expansions and Marketplaces in 2014, the U.S. significantly expanded access to health insurance coverage. Architects of the ACA rightly viewed Medicaid as an essential piece of the universal coverage puzzle. Indeed, Medicaid is a special piece of the coverage pie. This paper explains why it is essential for health coverage in the U.S. to maintain what makes Medicaid, Medicaid.

  • NHeLP Matters – December 2014

    Welcome to the year's final edition of NHeLP Matters. In the past 12 months, we have fought for the health care rights of low-income people and individuals with disabilities in Washington and beyond. Learn more about our work advancing reproductive health, protecting Medicaid and bringing together advocates and policy makers across the nation to strategize on ways to improve health care.

  • Due Process in Duals Demonstrations: A Closer Look at New York

    New York is one of several states working to better integrate care and services for individuals dually eligible for Medicare and Medicaid through a duals demonstration. In addition to integrating care, New York is working to integrate the Medicare and Medicaid appeals processes for individuals participating in its duals demonstration. This issue brief analyzes New York's integrated appeals process and examines the effects of integration on enrollees' due process rights.

  • NHeLP Comments on Amendments to Arkansas’s Health Care Independence Program

    Arkansas recently proposed amendments to its premium assistance Medicaid expansion demonstration, the Health Care Independence Program. These are NHeLP's comments to the proposed amendments, which include new premium and cost sharing provisions, limitations to nonemergency medical transportation, and a health care expenses account for premium assistance enrollees.

  • 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.

  • Q&A HCBS – Transition Plan Advocacy: Identifying the Issues

    This Q&A resource developed and written by NHeLP is for advocates working on, or considering, comments on State transition plans for Home and Community-Based Services (HCBS) programs. This document will help advocates: Identify changes needed in existing HCBS programs and the information within an organization that can be used to comment on transition plans for these programs; Understand the transition plan process and the connection to Olmstead advocacy; Develop inquiries by using the expertly crafted sample questions to ask when looking at a current HCBS program; Find compelling examples to demonstrate how current policies may not conform to the new standards in practice; and Identify the issue areas that may yield illustrations of current problems (e.g., services, housing or employment) as well as potential roadblocks that need to be addressed to ensure successful transition to more integrated services.

  • NHeLP Comments to Health Indiana 1115 Demonstrations

    These NHeLP comments to the State of Indiana address numerous legal problems with the states two proposed section 1115 demonstrations, one to expand Medicaid and one to renewal the current 1115 if the Medicaid expansion is denied. NHeLP comments identify problems such as illegal premiums, cost-sharing, and restrictions on benefits.

Load More