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 in Waivers and Demonstrations.
  • July 23, 2013

    Letter to CMS Administrator Tom Scully from Washington State Congressional Dele

    External Source

    Letter to CMS Administrator Tom Scully from Washington State Congressional Delegation

  • July 23, 2013

    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.

  • July 23, 2013

    Brief Medicaid Overview & Waivers

    Powerpoint Presentation: Brief Medicaid Overview & Waivers

  • July 23, 2013

    Home & Community Care: TBI & SC Waivers

    This powerpoint provides background on three typs of home and community based waivers for individuals who suffer traumatic brain injuries (TBI) or spinal cord injuries (SCI). Topics include available services, beneficiary protections, application of EPSDT, and relevant litigation.

  • July 23, 2013

    Kentucky District Court Issues Good Medicaid and ADA Decision

    The Kentucky P&A has received an excellent decision in Michelle P v. Holsinger, No. 3:02-23-JMH (E.D. Ky. Feb. 11, 2005). The case involves Medicaid and ADA challenges to a home and community based waiver waiting list.   The court finds the following Medicaid provisions are enforceable pursuant to section 1393: 42 USC 1396a(a)(10)(A) (requiring eligibility); 1396a(a)(10) (B) (requiring comparability); 1396a(a)(8) (requiring reasonable promptness of assistance); 1396n(c)(2)(C) (requiring freedom of choice of institutional or home-based services). The Court applied the federal right enforcement test as "tweaked" by Gonzaga to find that each of these provisions has an unambiguous focus on the individual and contains sufficient rights-creating language.    The Court found the defendant's motion to dismiss the ADA claim was inappropriate for a 12(b)(6) motion: "ince the Plaintiffs do not seek the creation of new programs, whether the relief requested would result in a fundamental alternation 'is a matter that can be resolved only by a careful examination of the facts and circumstances....''" quoting Martin v. Taft, 222 F. Supp. 2d 940, 975 (S.D. Ohio 2002).

  • July 23, 2013

    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 

  • April 15, 2013

    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.

  • April 11, 2013

    Health Advocate: Section 1115 Waivers: More than Meets the Eye

    This issue of the Health Advocate provides background on Medicaid Section 1115 waivers, which allow participating states an exception to some Medicaid requirements. Section 1115 waivers have been problematic and present a number of issues for health advocates as HHS has allowed states to use this authority to make changes that seem to reduce, not support, access to Medicaid coverage.

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