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

  • T.R. v. Dreyfus, U.S. District Court, Western District of Washington

    Litigation Team

    This class action lawsuit against the Washington State Department of Social and Health Services (DSHS) was brought on behalf of Medicaid-eligible children under age 21 in Washington State who were denied necessary intensive home and community-based mental health services. The lawsuit also claimed that the state has failed to comply with the American with Disabilities Act (ADA), which requires that public entities such as DSHS provide services to children with psychiatric disabilities in the most appropriate integrated setting.   In March 2012, the parties reached an Interim Agreement. The agreement suspended litigation while the State worked to build a framework for reform of the mental health system for children on Medicaid. Before the Interim Agreement expired, the parties negotiating a full settlement agreement. On September 27, 2013, the court granted preliminary approval of the proposed settlement, and on December 19, 2013, after a fairness hearing, granted final approval of the settlement.

  • Amicus: State of N.Y., et al. v. U.S. Dep’t Health & Human Servs., Southern District of New York

    Litigation Team

    National Health Law Program (NHeLP), Justice in Aging, and the Disability Rights Education and Defense Fund (DREDF) submitted an amicus brief in the Southern District of New York on behalf of themselves and 47 partners. The brief supports the State of New York and 22 other states’ motion for partial summary judgment against implementation of the Trump administration’s recently finalized rule to restrict the reach of Section 1557, the Affordable Care Act’s ground-breaking anti-discrimination provision. Our amicus argues that this Trump administration rule ignores the plain language of the ACA and is an arbitrary and capricious action by the administration. The 2020 changes to the 2016 Section 1557 rule include sharply limiting what entities must comply with Section 1557; eliminating notice, tagline, and effective communication requirements; and incorporating harmful exemptions from statutes not listed in the ACA, including religious exemptions. The Trump administration’s changes to the Section 1557 rule harm the very people that the ACA was intended to protect and removes critical protections that will impact millions of women, LGBTQ+ individuals, older adults, Black, Indigenous, and people of color (BIPOC), and individuals with limited English proficiency (LEP). The case in SDNY is one of several cases challenging the rule.

  • Katie A. v. Bonta, U.S. District Court for the Central District of California

    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 California’s failure to provide home-based and community-based mental health services to children who are in or at risk of foster care. A settlement agreement was reached in the state case in 2011 while the county case (Katie A. v Los Angeles County) reached a separate settlement agreement. The settlement required the state to make “intensive care coordination, intensive home based services, and therapeutic foster care available to children on Medi-Cal with mental health needs, to enable them to stay in their own homes and communities.

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