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

  • Amicus: Talevski v. Health and Hosp. Corp. of Marion Cty., U.S. Court of Appeals, Seventh Circuit

    Litigation Team

    The National Health Law Program and 11 other organizations filed this brief in the 7th Circuit in support of the Mr. Talevski, who is alleging the improper chemical restraint and discharge from a state-operated, Medicaid-funded nursing facility. Mr. Talevski’s family filed a lawsuit to enforce his rights under the Nursing Home Reform Act. The family appealed after the district court dismissed the case, holding that Medicaid enrollees cannot enforce the Nursing Home Reform Act. NHeLP’s brief focuses on the judicial and legislative history of private (as opposed to government) enforcement of the Medicaid Act.

  • D.H. v. Snyder, District of Arizona

    Litigation Team

    Two transgender young people enrolled in Medicaid filed a class action lawsuit challenging an Arizona regulation that prohibits coverage of medically necessary gender-confirming surgery. The plaintiffs allege that the discriminatory coverage exclusion violates: (1) the EPSDT requirements in the Medicaid Act; (2) the comparability requirement in the Medicaid Act; (3) Section 1557 of the Affordable Care Act; and (4) the Equal Protection Clause of the 14th Amendment.

  • Amicus: State of Washington v. U.S. Dep’t Health & Human Servs., Western District of Washington

    Litigation Team

    The National Health Law Program filed this brief, signed by 11 other organizations in support of the State of Washington’s efforts to enjoin the Administration’s changes to the rules for the ACA’s non-discrimination provision, Section 1557. The 2020 Revised Rule regarding section 1557 of the Patient Protection and Affordable Care Act will limit the anti-discrimination protections that are applied to all health insurers, including Medicaid and other Federal programs. The 2020 Revised Rule eliminated important protections against sex discrimination that will harm Lesbian, Gay, Bisexual, Transgender, Queer, Plus (“LGBTQ+”) individuals and women. It also eroded important notice and effective communication protections for people with limited English proficiency (LEP) and disabilities. And it erased whole categories of entities from coverage under Section 1557, including many private insurers and certain Federal programs.

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