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

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… results in Waivers and Demonstrations.
  • May 24, 2018

    Groups File Class Action Against Calif. Over Care of Children with Disabilities

    Representing children with disabilities, Disability Rights California, National Health Law Program and Western Center for Law and Poverty today filed a class action lawsuit in federal court against California's Medicaid agency (Medi-Cal) for failure to provide sufficient in-home nursing services. Medi-Cal's "deficient policies, practices, and procedures related to arrangement of in-home skilled nursing services violate not only ... provisions of the Medicaid Act, but also provisions of the Americans with Disabilities Act.

  • May 22, 2018

    National Health Law Program Urges HHS to Reject Arizona’s Retroactive Waiver

    National Health Law Program urges the U.S. Department of Health and Human Services Secretary to reject a Sec. 1115 Medicaid waiver proposal from Arizona that would end retroactive health care cover for thousands of low-income individuals and families in the state. The purpose of the Medicaid Act's retroactive coverage is to protect "persons who are eligible for Medicaid but do not apply for assistance until after they have received care, either because they did not know about the Medicaid eligibility requirements, or because the sudden nature of their illness prevented their applying." In comments to HHS, the National Health Law Program says, "Waiving retroactive coverage will harm low-income people and care providers. Without this protection, individuals are likely to incur significant medical costs if they need medical care and are not yet enrolled in coverage."

  • May 15, 2018

    Stewart v. Azar: Plaintiffs Reply to Government Motions to Dismiss

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    The Secretary of the U.S. Department of Health and Human Services has maintained in Stewart v. Azar that nothing in the Medicaid Act limits his ability to waive portions of it, the National Health Law Program, Kentucky Equal Justice Center and the Southern Poverty Law Center state in their May 14 reply to the motions by HHS and the Kentucky government to dismiss the lawsuit challenging HHS's approval of Kentucky's Medicaid waiver project. "The Secretary's approval also rewrites the purposes of the Act to 'restructure' Medicaid into a work-oriented program aimed at teaching people about commercial insurance. Encouraging individuals to work may be a worthy policy goal, but it is manifestly not the goal of Medicaid, which Congress enacted to provide 'medical assistance' and 'rehabilitation and other services' to those individuals  'whose income and resources are insufficient to meet the costs of necessary medical services," the advocates' reply states.

  • April 24, 2018

    National Health Law Program Urges HHS to Reject Arizona’s Medicaid Waiver Plan

    In comments to the U.S. Department of Health & Human Services (HHS), the National Health Law Program explains why Arizona's proposed Section 1115 Medicaid Waiver Amendment is flawed and legally suspect. Arizona's amended Medicaid waiver project includes an onerous work reporting requirement and lifetime limits on Medicaid. Work requirements are well-documented by extensive research that shows they do "little or nothing to increase stable, long-term employment and does not decrease poverty." Regarding Arizona's time-limit, the National Health Law Program notes, " Congress did not intend to limit Medicaid to temporary health care coverage. Instead, Congress designed Medicaid to furnish medical assistance to low-income individuals who cannot afford the costs of necessary medical care when and for long as they have a medical necessity for such assistance."

  • April 11, 2018

    Leading Health Law Scholars Urge Court to Reject KY Medicaid Waiver Project

    A group of the nation's leading health law scholars is urging the U.S. District Court for the District of Columbia to reject federal approval of Kentucky's Medicaid waiver program in Stewart v. Azar. The health law scholars state in their friend-of-the court brief, that HHS's approval of Kentucky's Medicaid waiver project was outside the parameters of the Medicaid program, because "the waiver will reduce coverage, and with it, ongoing care. Even the state's own numbers show that rather than improving Medicaid, its actions will cull the rolls of both people who qualify for Medicaid as part of the ACA expansion as well as those eligible under traditional program rules." The scholars brief continues that Congress did not intend for Sec. 1115 waivers to be used to limit access to Medicaid. This so-called "demonstration" waiver, "destroys, not improves, Kentucky's substantial health care achievements and defeats, rather than promotes, Medicaid's purpose as a safety net insurer," the scholars' brief states.

  • April 11, 2018

    Disability, Senior Rights Groups Urge Court to Reject KY Medicaid Waiver Project

    Justice In Aging, AARP Foundation, National Academy of Elder Law Attorneys, Disability Rights Education and Defense Fund urge the U.S. District Court for the District of Columbia in Stewart v. Azar to reject HHS's approval of Kentucky's waiver project that includes an onerous work requirements program, premiums, lock-outs, and other obstacles to Medicaid. "If implemented, the Kentucky Waiver will harm low-income persons with functional limitations and chronic conditions of all ages, but especially those ages 50 to 64. The results will be more low-income people without health care and without the ability to gain independence and provide self-care," the groups state in their friend-of-the-court brief.

  • April 10, 2018

    NHeLP Comments to HHS on Mississippi Waiver

    In comments to the U.S. Department of Health & Human Services (HHS), the National Health Law Program urges the Secretary to reject Mississippi' Sec. 1115 Medicaid waiver project, so-called "Medicaid Workforce Training Initiative."  The state's waiver scheme imposes onerous work requirements, which stands "Medicaid's purpose on its head by creating barriers to coverage and the pathway to health that the coverage represents." This punitive policy would cover fewer people and increase the ranks of the uninsured. The National Health Law Program argues that Mississippi's program would, by design, leave individuals without access to Medicaid, or any affordable coverage option. Moreover, as Mississippi has not expanded Medicaid under the Affordable Care Act, the population most affected by the work requirements would be parents and caretakers.

  • April 10, 2018

    NHeLP Comments to HHS on New Mexico Waiver

    In comments to the U.S. Department of Health & Human Services (HHS), the National Health Law Program urges the Secretary to reject New Mexico's Sec. 1115 Medicaid waiver project, so-called "Centennial Care." While it includes several true experimental pilots, such as a pilot to improve access to long-acting reversible contraceptives for women and another to provide in-home prenatal and postpartum care, the application also proposes numerous waivers likely to impede access to coverage and care for low-income New Mexicans. These provisions do not promote the objectives of the Medicaid program and should not be approved, including new premiums with disenrollment and lockouts for nonpayment, high co-payments for non-emergency use of the Emergency Department, termination of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for 19-20 year olds, thinner benefit packages for parents and caretakers, limited family planning eligibility, termination of Transitional Medical Assistance for low-income parents, and a phase out of retroactive eligibility. Finally, while the proposal includes increased funding for treatment of substance use disorders and mental health conditions, the National Health Law Program argues that the resources should be focused on proven, community-based treatments supported by available evidence, rather than institutional care.

  • April 1, 2018

    Stewart v. Azar, Summary Judgement Motion in HHS KY Medicaid Waiver Case

    The Trump administration's approval of Kentucky's Medicaid waiver project with its onerous work requirements and other legally suspect obstacles to health care for low-income individuals violates Medicaid law because the administration has "effectively rewritten the Medicaid Act, bypassing congressional restrictions by regulatory fiat, overturning a half century of administrative practice, ignoring large swaths of social science evidence and data, and threatening irreparable harm to the health and welfare of tens of thousands of people," state National Health Law Program, Kentucky Equal Justice Center, and the Souther Poverty Law Center (SPLC) in their Memorandum In Support Of Motion For Summary Judgement in Stewart v. Azar. The health and human rights groups, representing more than a dozen Kentucky Medicaid beneficiaries, sued the Trump administration in January in federal court arguing that the approval of Kentucky's Medicaid wavier scheme was illegal, and must be rescinded.

  • March 19, 2018

    NHeLP Comments to HHS on Kansas’ Sec. 1115 Medicaid Waiver Project

    In comments to the U.S. Department of Health & Human Services (HHS), National Health Law Program urges the Secretary to reject Kansas' Sec. 1115 Medicaid waiver project, so-called "KanCare 2.0."  The state's waiver scheme includes imposing work requirements on eligibility, extended lockout periods, lifetime limits, and a coercive incentive for beneficiaries to discontinue a Social Security disability determination, which are all punitive measures that will only bring further harm to beneficiaries, cause thousands to lose Medicaid coverage, and reduce access to necessary care, the National Health Law Program states in its comments to HHS.

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