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.
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- April 10, 2014
The Pennsylvania 1115 Medicaid proposal is an extremely dangerous one. Under the guise of expanding Medicaid it would enact historic cuts to the state's Medicaid program. Second, it tries to waive core Medicaid requirements. Approval of this demonstration as requested would be a serious harm to Medicaid enrollees in PA and beyond.
- March 25, 2014
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.
- March 18, 2014
This issue of the Health Advocate covers how states are implementing the Medicaid expansion authorized by the ACA using premium assistance.
- February 18, 2014
This issue of the Health Advocate provides an overview of Medicaid Home and Community Based Services (HCBS). HCBS programs are intended to support states in creating a comprehensive system of long-term care services in the community, as is consistent with the community integration mandate established by the Supreme Court in the Olmstead v. L.C. case in 1999.
- February 11, 2014
Q&A: Home and Community-Based Services-Final RulesMedicaid-funded home and community-based services are critical to community integration for older adults and individuals with disabilities. Defining the types of settings in which these services are provided is important in ensuring the services are not provided in settings that are institutional in nature, but instead promote access to the community. This Q&A discusses the new rules, the definition of home and community-based settings, the transition process, advocacy opportunities, and other new features for Medicaid waivers and programs under these new rules.
- October 3, 2013
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.
- September 6, 2013
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.
- August 29, 2013
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.