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

  • NHeLP Comments on Oklahoma Section 1115 Institutions for Mental Disease (IMD) Waiver for Serious Mental Illness/Substance Use Disorder

    NHeLP urges the Secretary not to approve the requested waiver because 1) Oklahoma asks the Secretary to waive provisions of the Medicaid Act the Secretary does not have the authority to waive; 2) Oklahoma has not proposed a genuine experiment or novel approach; 3) Oklahoma’s proposal risks diverting funds away from community-based services, undermining decades of progress toward increased community-integration; and 4) the Secretary does not have authority to approve a Section 1115 waiver that would enable Qualified Residential Treatment Programs (QRTPs) to receive federal financial participation (FFP) for psychiatric treatment for individuals under 21 with SMI.

  • NHeLP Comments on MassHealth SMI-SED Supplmental Application Waiver

    In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Massachusetts' proposed request to waiver to obtain federal finanical participation for services provided in Institutions for Mental Diseases (IMD). HHS should reject Massachusett's application because Massachusetts did not provide adequate state-level notice and opportunity to comment prior to submitting this amendment. Further, HHS does not have authority to grant the request to waive the IMD exclusion because Massachusetts has not proposed a genuine experiment, and the Secretary may only waive requirements of the federal Medicaid Act to conduct an experiment or test a novel approach to improve medical assistance for low-income individuals. Furthermore, Section 1115 only permits waiver of those requirements found in 42 U.S.C. § 1396a, and the IMD exclusion lies outside of 42 U.S.C. § 1396a. Last, the proposal risks diverting funds away from appropriate community-based services, undermining decades of progress towards increased community-integration.

  • Katie A. v. Los Angeles County, Central District of California/Western Division

    Litigation Team

    Katie A. v. Bonta is a class action lawsuit that was filed in July 2002 against California’s State Departments of Health Care Services and Social Services (the state case), as well as Los Angeles County and its child welfare agency (the county case). It challenges the State and County’s failure to provide necessary home-based and community-based mental health services to children who are in or at risk of foster care. A settlement agreement with Los Angeles County was reached in 2003 wherein the County agreed to close its large shelter facility for foster youth - MacLaren Children’s Center - and to develop appropriate child welfare and mental health services in the community. An expert Advisory Panel was established as part of the settlement agreement to monitor implementation and assist the County. While one lawsuit was filed against both the State and LA County, this part of the case is known as Katie A. v. Los Angeles County.   In 2019 the County moved to end the agreement and dismiss the litigation. In September 2020, a new settlement agreement was reached between the parties. The new agreement requires by the County to take specific steps over a period of approximately…

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