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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- 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.
- April 8, 2019
In a recent webinar, National Health Law Program Legal Director Jane Perkins and Senior Attorneys Catherine McKee and Elizabeth Edwards discussed the recent federal court decisions blocking work requirements and other coverage restrictions in the Kentucky and Arkansas Medicaid programs. They discussed the cases as well as key takeaways and unanswered questions. The National Health Law Program, along with national and state partners, challenged the HHS approval of Medicaid work requirements in Stewart v. Azar and Gresham v. Azar. Download the webinar below.
- March 20, 2019
On November 30, 2018, the Department of Health and Human Services (HHS) approved New Hampshire’s request to condition Medicaid coverage of medically necessary services needed by low-income adults on work requirements and to waive retroactive coverage. The project is called “Granite Advantage.” Because Granite Advantage violates numerous provisions of federal law and will gravely harm tens of thousands of New Hampshire residents, the National Health Law Program (NHeLP) and co-counsel New Hampshire Legal Assistance and National Center for Law and Economic Justice filed a lawsuit challenging the approval on March 20, 2019.New Hampshire is currently implementing the approved waiver. Retroactive coverage ended on January 1, 2019. Individuals must begin completing work activities in June 2019, and could lose their coverage due to noncompliance beginning August 1, 2019.The class action lawsuit was filed on behalf of four individuals who currently obtain their health care through Medicaid and will suffer serious harms under Granite Advantage. Below are descriptions of how NH Granite Advantage will affect the named plaintiffs: Samuel Philbrick is 26 years old and lives in Henniker with his mother and father. Mr. Philbrick currently works as a cashier in a sporting goods store where he makes $11.33 per hour.…
- October 26, 2018
In comments to the U.S. Department of Health and Human Services, the National Health Law Program urges the department to reject Michigan’s Sec. 1115 Medicaid waiver application, because it would increase premiums and impose unlawful conditions of eligibility, including required healthy behavior and work-related activities. In previous comments to HHS, the National Health Law Program has detailed why even the existing premiums and cost sharing structure decrease enrollment and access to care and should not have been approved. Subsequent evidence has shown that the existing premiums and healthy behavior policies are increasing medical debt and depressing enrollment. The proposed changes will only exacerbate these problems. Additionally, the proposed changes do not comply with § 1115 of the Social Security Act, as they will block, rather than facilitate, access to Medicaid coverage.
- August 18, 2018
National Health Law Program in comments to the U.S. Department of Health and Human Services, again, urged the agency to reject Kentucky's proposed Medicaid waiver plan that was invalidated by a U.S. District Court in Stewart v. Azar. The Kentucky plan is again before HHS because the district court remanded it to the agency with direction to re-consider, within the bounds of Medicaid law, the legality of Kentucky's proposed plan. National Health Law Program again argues that the Kentucky waiver plan will lead to substantial numbers of individuals and families losing health care coverage, with many of them unable to meet the onerous requirements of Kentucky's work requirement. The work requirement's attempt at exempting "medically frail" individuals, data shows, will not do so adequately leaving many individuals with disabilities "more likely to lose benefits."
- July 6, 2018
Centers for Medicare & Medicaid Services (CMS) should reject the Kentucky governor's "Alternative Benefit Plan (ABP) State Plan Amendment (SPA)," which took effect on July 1, according to the National Health Law Program, Kentucky Equal Justice Center and the Southern Poverty Law Center in a July 6 letter sent to Acting Director of CMS Timothy Hill. The groups are representing Kentuckians in a federal lawsuit challenging HHS's approval of Kentucky's Section 1115 waiver plan, which includes onerous restrictions on Medicaid services. On June 29, a federal court vacated and remanded the Kentucky waiver plan to the U.S. Department of Health and Human Services. In their July 6 letter to CMS, the groups argue that the Kentucky governor's application to cut vision, dental, and non-emergency medical transportation services is procedurally flawed, and therefore CMS must reject it and reverse the cuts to Medicaid services in Kentucky.
- June 13, 2018
What you need to know about June 15 oral argument in the federal class action lawsuit from Kentuckians challenging the Trump administration's approval of an onerous Medicaid waiver scheme that includes burdensome work requirements, high premiums, lock outs, and elimination of retroactive health care coverage. Read National Health Law Program's guide on what to expect from oral argument by Mara Youdelman and Jane Perkins.