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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- December 22, 2022
An Advocate’s Guide to Medi-Cal Services
Fabiola De Liban, Amy Chen, Abigail Coursolle, Alicia Emanuel, Héctor Hernández-Delgado, T. Nancy Lam, Kimberly Lewis, Carly Myers, Alexis Robles-Fradet, Skyler Rosellini, and Jasmine Young GuideThe National Health Law Program is pleased to present our updated 2022 Advocates Guide to Medi-Cal Services. NHeLP's Medi-Cal Services Guide, first released in 2020, provides an in-depth description of some of the most important services covered in the Medi-Cal program, including prescription drug services, mental health and substance use disorder services, reproductive and sexual health services, gender-affirming services, dental services, children services, among others. The 2022 updated guide focuses on key changes the Medi-Cal program has undergone in recent years. In particular, relevant chapters now emphasize policy changes implemented pursuant to the California Advancing and Innovating Medi-Cal (CalAIM) initiative, including a new chapter on Case Management and Community-Support Services, which provides insight on new services that have become widely available through implementation of CalAIM. There is also a new addendum summarizing Medi-Cal's telehealth policy in light of changes adopted during the COVID-19 pandemic. The entire guide can be downloaded or individual chapters accessed below.
- November 21, 2022
NHeLP comments on New Hampshire SUD/SMI/SED Treatment and Recovery Access Demonstration Extension Request
In comments to the Department of Health and Human Services, the National Health Law Program asks the Secretary to reject New Hampshire's request to waive the IMD exclusion. We further urges HHS to reject the request to obtain federal funding for children that are in IMDs. Last, to the extent that HHS allows New Hampshire to obtain federal funding for reentry services, we ask that HHS consider including the guardrails and limitations suggested in these comments.
- November 8, 2022
Case Summary: Georgia v. Brooks-LaSure – Medicaid Work Requirements Reappear
Jane Perkins and Erica Turret* Fact Sheet, Guide, Case ExplainerA federal court in Georgia has set aside a decision by the Centers for Medicare & Medicaid Services (CMS) that had rescinded the work requirement and premium components of a section 1115 Medicaid project. The US Department of Justice did not appeal the ruling. Georgia becomes the only state in the country currently allowed to implement a Medicaid work requirement. This issue brief reviews the case, Georgia v. Brooks-LaSure, No. 2:22-cv-6, 2022 WL 3581859 (S.D. Ga. Aug. 19, 2022). *Erica Turret is a Jenner & Block Pro Bono Fellow at the National Health Law Program
- October 13, 2022
NHeLP Comments on California Section 1115 Demonstration Five-Year Renewal and Amendment Request: CalAIM Demonstration
In comments to HHS, NHeLP urges the Secretary to reject California's plan to renew its Institution for Mental Diseases (IMD) waiver for Medi-Cal beneficiaries with SUD. The comments emphasize concerns with flexibilities sought by the State to allow for longer stays at IMDs for both minors and adults. In addition, NHeLP's comments demonstrate support for several new services, such as peer support services, but caution that the use of a Section 1115 waiver instead of a state plan amendment is inappropriate. Finally, NHeLP urges both California and HHS to require all counties to participate in the expanded SUD program.
- October 5, 2022
Comments on Missouri Section 1115 Request for Federal Funding for Institutions for Mental Disease (IMDs) for Children and Adults
In these comments, NHeLP urges HHS to reject Missouri's request for federal financial participation for institutions for mental disease, as increasing federal funding for institutional care risks serious harm, particularly for children. NHeLP objects to the use of Section 1115 for this purpose, and to the request to eliminate time limits on length of stay for children for up to two years.
- September 16, 2022
Washington Medicaid Transformation Project Demonstration Extension Request
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to ensure that appropriate guardrails are placed on any Medicaid funding for prison, jail, and other institutional re-entry, to ensure that it is used strictly for services that aid in reentry and that is primarily used for home and community based services. We also urge HHS to reject Washington's request to waive the Institutions for Mental Diseases (IMD) exclusion for certain psychiatric and substance use disorder facilities.
- September 7, 2022
Washington Medicaid Transformation Project Demonstration Extension Request
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to ensure that appropriate guardrails are placed on any Medicaid funding for prison, jail, and other institutional reenty, to ensure that it is used strictly for services that aid in re-entry and that is primarily used for home and community based services. We also urge HHS to reject Washington's request to waive the Institutions for Mental Diseases (IMD) exclusion for certain psychiatric and substance use disorder facilities.
- July 17, 2022
NHeLP Comments on West Virginia Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorders (SUD) Demonstration Extension Request
Hector Hernandez-Delgado CommentsIn comments to HHS, NHeLP urges the Secretary to reject West Virginia's Section 1115 demonstration extension request to continue waiving the Institutions for Mental Diseases (IMD) exclusion. This letter emphasizes that while NHeLP is supportive of efforts to increase access to services for Medicaid beneficiaries with substance use disorders (SUD), the Secretary has no statutory authority to waive the exclusion, particularly to extend demonstrations with no particular experimental value. In addition, several policy reasons are given to underscore the need to prioritize other more effective efforts that pose less risk of subjecting beneficiaries to harmful institutionalization.
- June 7, 2022
Medicaid, Child Welfare & Institutional Care: Qualified Residential Treatment Programs
A landmark foster care reform law, the Family First Prevention Services Act, was intended to ensure that children are able to live in family-like settings and reduce reliance on unnecessary institutional care. In doing so, the new law put a spotlight on a longstanding Medicaid law and policy that prohibits states from obtaining federal funds for services provided to residents of mental health facilities with more than 16 beds. This exclusion has existed since Medicaid was enacted in 1965, and plays an oft misunderstood and underappreciated role in incentivizing states to provide services in smaller, more community-based settings. This issue brief discusses the intersection of the IMD exclusion with foster care placements and advocates for a path forward where federal funding continues to be used to further the goal of keeping children with families.
- June 6, 2022
NHeLP Comments on Healthy Louisiana Substance Use Disorder 1115 Demonstration Extension Request
Hector Hernandez-Delgado CommentsIn comments to HHS, NHeLP urges the Secretary to reject Louisiana's Section 1115 demonstration extension request to continue waiving the Institutions for Mental Diseases (IMD) exclusion. This letter emphasizes that while NHeLP is supportive of efforts to increase access to services for Medicaid beneficiaries with substance use disorders (SUD), the Secretary has no statutory authority to waive the exclusion, particularly to extend demonstrations with no particular experimental value. In addition, several policy reasons are given to underscore the need to prioritize other more effective efforts that pose less risk of subjecting beneficiaries to harmful institutionalization.