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

results in Waivers and Demonstrations.
  • Comments to 1332 Guidance (2018)

    Comments to 2018 CMS Guidance Weakening 1332 Standards.

  • Sec. 1115 Waiver Tracking Chart

    Sec. 1115 of the Social Security Act allows the Secretary of HHS to waive some requirements of the Medicaid Act so that states can test novel approaches to improving medical assistance for low-income people. While historically states have proposed waivers that did indeed propose innovative approaches to improve Medicaid and expand coverage, now, at HHS’s urging, several states are seeking waivers to impose harmful cuts and restrictions. The first set of harmful waivers have been approved for Kentucky, with a number of state’s poised to enact similar changes to Medicaid. This chart provides an overview of the harmful waiver provisions that have been proposed to-date. (Chart updated as of December 14, 2020)  

  • NHeLP Comments on HHS Regulations Rule (aka SUNSET Rule)

    In the Regulations Rule, HHS seeks to retroactively impose a mandatory expiration date on an estimated 18,000 duly promulgated regulations. Even long-standing rules would be automatically rescinded unless they survive a complex process of assessment and review. Programs like Medicaid and the Children's Health Insurance Program (CHIP) could be devastated if important regulations are arbitrarily rescinded. In comments, NHeLP pushes back against this unlawful and ill-conceived proposal designed to sabotage HHS safety net programs.

  • 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 Supplemental 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.

  • Utah 1115 IMD Demonstration Request Comment

    Utah has applied for an 1115 demonstration waiving the IMD exclusion for people with serious mental illnesses. NHeLP submitted a comment opposing the demonstration request.

  • NHeLP comments on HHS Proposed Rule on Guidance

    Guidance documents are a valuable tool that allows agencies to clarify policy issues and explain ambiguities raised by the laws and rules they are tasked with implementing. Programs like Medicaid and the implementation of the Affordable Care Act depend heavily on guidance documents to clarify coverage requirements and the obligations of state programs serving low income communities. However, a HHS proposed “good guidance " rule would open the door to the administration repealing important guidance without notice or explanation, and would create a time-consuming and burdensome process to reinstate or implement new guidance. In these comments, NHeLP explains why the proposed "good guidance" rule would be, in fact, harmful, and urge HHS to withdraw the proposed rule.

  • Comments: Oklahoma Section 1115 Application.

    In comments to the Department of Health and Human Services, the National Health Law Program asks HHS to reject Oklahoma's proposed project, which would impose a number of unlawful conditions on coverage and access to care. Oklahoma also requested permission to shift to per capita cap funding for the Medicaid expansion population.

  • Top Ten List: Medicaid Eligibility & Enrollment in Light of COVID-19

    This publication identifies ten actions that advocates can take to maximize eligibility and enrollment in Medicaid during and after the COVID-19 emergency.

  • Letter Calls on Seema Verma to Reject Oklahoma’s Section 1115 Request Following Ballot Initiative

    In a letter to the Center on Medicare & Medicaid Services, the National Health Law Program requested that Administrator Verma reject Oklahoma's SoonerCare 2.0 application. The proposed 1115 waiver project would violate recent changes to Oklahoma law following the June 30, 2020 ballot initiative that amended the Oklahoma Constitution to require the state to expand Medicaid. The ballot initiative included several protections for the expansion population, which would conflict with the SoonerCare2.0 proposal.

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