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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- October 11, 2019
In comments to the Center for Medicare and Medicaid Services (CMS), the National Health Law Program urged the agency to adopt an Action Plan to Prevent Opioid Addiction and Enhance Access to Medication-Assisted Treatment (MAT) that recognizes the inherent value of the Medicaid program as a tool to combat the epidemic. Numerous studies have demonstrated that states that expanded Medicaid under the Affordable Care Act have experienced a significant increase in the number of individuals with substance use disorders accessing treatment because of increased availability of services. In addition, CMS should continue to highlight the importance of MAT as the gold standard of care for treatment of substance and opioid use disorders and to encourage states to remove any barriers to accessing MAT for beneficiaries diagnosed with these conditions.
- October 3, 2019
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 Oct 3, 2019)
- September 23, 2019
Indiana began implementing Medicaid work requirements on January 1, 2019. On December 31, 2019, the State will begin suspending the coverage of individuals who have not met the work requirements. Indiana estimated that once fully implemented, the work requirements would result in roughly 24,000 individuals losing Medicaid coverage each year for failing to comply. Because Healthy Indiana 2.0 violates numerous provisions of federal law and will gravely harm tens of thousands of Indiana residents, the National Health Law Program (NHeLP) and co-counsel Indiana Legal Services filed a lawsuit challenging the approval. The lawsuit was filed on behalf of four individuals who currently obtain their health care through Medicaid and will suffer serious harms as a result of the HIP 2.0 extension. This resource discusses how HIP 2.0 has and will continue to affect the named plaintiffs.