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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- April 28, 2021
NHeLP comments in support of Senators Brown, Casey, and Hassan and Representative Dingell's HCBS Access Act discussion draft.
- April 27, 2021
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Alabama’s proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. First, 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, and Alabama has not proposed a genuine experiment or novel approach. Second, Alabama asks the Secretary to waive provisions of the Medicaid Act the Secretary does not have the authority to waive. Section 1115 only permits the waiver of those requirements found in 42 U.S.C. § 1396a, and Alabama requests a waiver of provisions outside of 42 U.S.C. § 1396a, including the “Institution for Mental Diseases” (IMD) exclusion. Third, Alabama’s proposal risks diverting funds away from community-based services, undermining decades of progress toward increased community integration. Last, Alabama proposes several reforms that simply do not require any wavier of the Medicaid Act. Such reforms should be pursued outside of the context of a waiver.
- April 27, 2021
In this application, New Mexico seeks to waive the Institutes for Mental Disease (IMD) exclusion, implement High Fidelity Wraparound Services for an initially limited group of children and youth, institute a Graduate Medical Education Program, and establish vaccine coverage for limited beneficiary categories. For a variety of reasons, NHeLP suggests that the Secretary not approve this amendment request. In particular, NHeLP notes that the state has failed to provide evidence that many of these programs are genuine experiments. Further, HHS does not have the authroity to waive the IMD exclusion because the exclusion is found outside of 42 U.S.C. § 1396a. Additionally, waiving the IMD exclusion would undercut community-based mental health services. Finally, NHeLP notes that intensive care coordination services like High Fidelity Wraparound should be provided as a medically necessary service to all children and youth under the age of 21 through the state's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mandate.