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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  • Pashby v. Cansler, Eastern District of North Carolina

    Litigation Team and

    Class of Medicaid beneficiaries who received in-home personal care services challenged State’s decision to narrow the standards for assessing need for in home assistance and practice of favoring services provided in adult care homes over services provided in homes of Medicaid beneficiaries. Partners: Disability Rights NC, Charlotte Center for Legal Advocacy (Formerly Legal Services of Southern Piedmont)

  • KC and LS v. Wos & Shipman, United States District Court, Eastern District of North Carolina

    2011 Medicaid beneficiaries with disabling and chronic conditions challenged North Carolina’s failure to ensure that managed care organizations provided them with adequate notice and opportunity for a hearing when their developmental disability services were reduced or terminated using arbitrary and non-ascertainable standards, denying beneficiaries a meaningful opportunity to challenge the benefit reductions or terminations. Partner: Charlotte Center for Legal Advocacy (Formerly Legal Services of Southern Piedmont)

  • T.R. v. Dreyfus, Western District of Washington

    2011 Medicaid eligible children and youths under 21 years old, with mental health needs, brought this lawsuit to obtain intensive home and community-based mental health services which they are entitled to through Medicaid’s Early and Periodic Screening, Diagnosis and Treatment provisions. Partners: Disability Rights Washington, National Center for Youth Law, Perkins Coie LLP

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