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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- July 7, 2020
Letter Calls on Seema Verma to Reject Oklahoma’s Section 1115 Request Following Ballot Initiative
In a letter to the Center on Medicare & Medicaid Services, the National Health Law Program requested that Administrator Verma reject Oklahoma's SoonerCare 2.0 application. The proposed 1115 waiver project would violate recent changes to Oklahoma law following the June 30, 2020 ballot initiative that amended the Oklahoma Constitution to require the state to expand Medicaid. The ballot initiative included several protections for the expansion population, which would conflict with the SoonerCare2.0 proposal.
- April 23, 2020
Letter Calls on Seema Verma to Reject Oklahoma’s Section 1115 Request as Incomplete
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
States Should Consider High Costs of Work Requirements
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
Letter to CMS Requesting Extension for TennCare II Demonstration Comment Period
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 TennCare II Amendment 42 Waiver Application
NHeLP comments to Tennessee's 1115 waiver project requesting to implement a Medicaid block grant.
- December 6, 2019
Comments: Utah 1115 Demonstration Waiver Amendment
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
Letter to CMS Concerning TennCare II Demonstration
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
Comments: Idaho’s Family Planning Referrals Section 1115 Waiver Application
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.