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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- District of Columbia
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- September 23, 2019
Indiana residents enrolled in Medicaid filed a lawsuit against the Trump administration challenging its extension of a Section 1115 project (HIP 2.0) allowing the State to condition Medicaid eligibility on compliance with work requirements. The approval also permits Indiana to charge enrollees premiums; terminate coverage and prohibit re-enrollment in Medicaid for failure to pay; impose a lockout penalty for failure to complete the redetermination process on time; eliminate retroactive eligibility; and eliminate NEMT. These changes have caused and will continue to cause tens of thousands of low-income individuals to lose access to Medicaid coverage and services.
- September 23, 2019
On February 1, 2018, the U.S. Department of Health and Human Services (HHS) approved Indiana’s request to condition Medicaid coverage of needed health care on work requirements. The approval, which extended the “Healthy Indiana Plan 2.0” (HIP 2.0) project, also allows the State to require low-income enrollees to pay a monthly premium, to be locked-out of coverage for failing to pay or to complete certain paperwork, and to eliminate retroactive coverage and coverage of non-emergency medical transportation. Because HHS’s approval of the HIP 2.0 extension violates numerous provisions of law and will harm tens of thousands of individuals in Indiana, the National Health Law Program, joined by Indiana Legal Services and Jenner & Block, LLP, filed a lawsuit challenging it on September 23, 2019.