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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- April 23, 2020
In an April 23rd letter to Seema Verma, the Administrator of the Centers for Medicare & Medicaid Services, the National Health Law Program asked the Administrator to withhold issuing a letter of completeness for Oklahoma's Section 1115 SoonerCare 2.0 application. A letter of completeness would trigger federal review of the project. As proposed, SoonerCare 2.0 would impose coverage restrictions, including work requirements, and transform Medicaid from entitlement to per capita funding. On March 17, 2020, the National Health Law Program wrote to Administrator Verma asking her to require the State to postpone the public comment process for this application due to the COVID-19 emergency. The State did not do that, and instead held four "virtual" meetings. As explained in the letter, these meetings failed to satisfy the State’s public comment obligations under Section 1115 and CMS’s implementing regulations and disproportionately excluded the low-income individuals most likely affected by the project.
- March 24, 2020
Multiple courts have held it unlawful to condition Medicaid coverage on a work requirement. Yet, some states continue to consider them. In addition to the litigation history to date, policymakers in those states should consider the practical realities of work requirements. This fact sheet looks at some of the significant costs associated with administering work requirements. (Updated May 2020)
- February 7, 2020
NHeLP Comments on Idaho Behavioral Health Transformation Section 1115 Medicaid Waiver Demonstration Application
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Idaho's proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. HHS does not have authority to grant the request to waive the IMD exclusion because Idaho 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.
- December 23, 2019
On Monday, December 23, 2019, the National Health Law Program sent a letter to CMS Administrator Seema Verma asking her to extend the public comment period for Tennessee’s section 1115 waiver application that seeks to transform the State’s Medicaid program into a block grant. The CMS comment site is blocking and/or deterring submission of comments from the public—a problem first detected over the weekend.
- December 19, 2019
NHeLP comments to Tennessee's 1115 waiver project requesting to implement a Medicaid block grant.
- December 6, 2019
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Utah's proposed project, which would impose a number of unlawful conditions on coverage and access to care. Utah requested a number of restrictions, including: capping enrollment in the expansion population; imposing work requirements; charging premiums (and terminating coverage and imposing a lockout penalty for failure to pay); charging an amount higher than otherwise permitted for non-emergency use of the emergency room; eliminating hospital presumptive eligibility; imposing a lockout penalty for an "intentional program violation;" eliminating EPSDT for people ages 19 and 20; cutting services for parents; and ignoring various managed care protections. The comments explain why the proposed project does not comply with the requirements of § 1115 of the Social Security Act.
- November 26, 2019
In a letter to administrator Seema Verma, the National Health Law Program has asked CMS to return Tennessee’s recently submitted section 1115 application to the State. Tennessee says the proposal would create a block grant. However, the NHeLP letter says the proposal is so short on specifics and is vague to the point where the public will not be able to meaningfully review and comment on it.
- November 26, 2019
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Idaho's request to require individuals to obtain a referral from their primary care provider before receiving family planning services from a different provider. The comments explain why the proposed project would reduce access to medically necessary preventive care, leading to worse health outcomes for low-income people in Idaho.
- October 16, 2019
NHeLP comments on Indiana’s Serious Mental Illness/Serious Emotional Disturbance Section 1115 Waiver Request
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Indiana’s proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. HHS, however, does not have authority to grant the request to waive the IMD exclusion because Indiana 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.
- 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.