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

  • NHeLP comments on Approved Drug Products with Therapeutic Equivalence Evaluations (the “Orange Book”)

    The Orange Book is an important and informative drug resource for a range of stakeholders. In a request for comments, FDA seeks feedback on the types of people or entitles using the Orange Book, additional information and features to incorporate into the Orange Book, and therapeutic equivalence information. NHeLP comments offer a number of suggestions that would make the Orange Book more widely and readily accessible to the communities actually using the medications.

  • 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.

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