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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  • Restrictions on the Scope of Section 1115 Waivers in the Medicaid Program

    Restrictions on the Scope of Medicaid Waivers Under ' 1115 of the Social Security Act In August, 2001, the Centers for Medicare and Medicaid Services (CMS) announced the Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative. HIFA encourages states to seek waivers of various provisions of the Medicaid Act and the State Children=s Health Insurance Program in order to expand basic health insurance coverage to groups not currently eligible to receive benefits under those programs.  In return, CMS has promised the states fast-track consideration of their waiver requests, and the "flexibility" to limit the benefits and rights of some current recipients in order to meet CMS= requirement that any expanded coverage not cost the federal government any more money than it is now paying to a state.  With HIFA, CMS has once again focused attention on its powers under ' 1115 of the Social Security Act (42 U.S.C. '1315) to waive various provisions of the Medicaid Act in furtherance of "demonstration projects." This paper examines some of the substantive and procedural limitations on those powers.   The language of ' 1115 provides the starting point for any analysis of the scope of CMS= waiver authority.  It states,…

  • HIFA: Will It Solve the Problem of the Uninsured?

    HIFA: Will It Solve the Problem of the Uninsured?

  • What is HIFA and Why Should We Be Concerned?

    In August, 2001, the Centers for Medicare and Medicaid Services (CMS) announced the Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative.  HIFA encourages states to seek waivers of various provisions of the Medicaid Act and the State Children?s Health Insurance Program (SCHIP) to expand basic health insurance coverage to groups not currently eligible to receive benefits.  In return, CMS has promised the states fast-track consideration of their waiver requests.      However, CMS has also required that a state?s resulting waiver program, with the expansion in coverage contemplated by HIFA, must not cost the federal government any more money over the life of the waiver than it would have paid without the waiver.  In this time of state budget stress, it is likely that this budget neutrality requirement will result in significant benefit cuts for those already receiving assistance, cost-sharing requirements beyond those authorized by the statute (in a provision that is not properly subject to waiver), and/or the imposition of enrollment caps and waiting lists in Medicaid.    HIFA divides Medicaid and SCHIP recipients into three groups:  mandatory, optional, and expansion.   Those in mandatory groups (see Mandatory vs. Optional Eligibility in Medicaid)…

  • Letter to HHS Secretary Thompson from Senators Baucus and Grassley

    External Source

    Letter to HHS Secretary Thompson from Senators Baucus and Grassley

  • Response Letter from HHS Secretary Thompson to Senators Baucus and Grassley

    External Source

    Response Letter from HHS Secretary Thompson to Senators Baucus and Grassley

  • Letter to CMS Administrator Tom Scully from Washington State Congressional Dele

    External Source

    Letter to CMS Administrator Tom Scully from Washington State Congressional Delegation

  • GAO Report on 1115 Waivers

    External Source

    This GAO report discusses the role and ability of HHS to effectively monitor, review, approve, and seek public input on 1115 waivers as states increasingly rely on this program to deliver care.

  • Brief Medicaid Overview & Waivers

    Powerpoint Presentation: Brief Medicaid Overview & Waivers

  • Medicaid Program – Demonstration Proposals Pursuant to Section 1115(a) of the Social Security Act

    Medicaid Program; Demonstration Proposals Pursuant to Section 1115(a) of the Social Security Act; Policies and Procedures 

  • 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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