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 and All United States.
  • February 2, 2024

    Case Update: Supplemental Complaint file in Rose v. Becerra

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    This case update focuses on Rose v. Becerra, which challenges approval of a Section 1115 Medicaid project in Indiana. CMS has recently reapproved the project, which allows Indiana to continue imposing premiums on very low-income people and to waive retroactive coverage and non-emergency medical transportation. This case update provides background and explains events leading up to filing the Supplemental Complaint.

  • May 30, 2023

    Trends in State Medicaid Continuous Coverage Unwinding Plans

    As part of the Medicaid continuous coverage unwinding, states were required to create plans to describe how they will redetermine the eligibility of all Medicaid enrollees. This paper identifies some of the major trends affecting beneficiaries in available unwinding plans including choices that may affect coverage loss and ease of beneficiaries in completing redeterminations. Although there are many choices states may make in unwinding and not all of those choices may be reflected in a state's plan, this paper focuses on trends most likely to impact coverage.

  • April 17, 2023

    What Makes Medicaid, Medicaid?

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    With the passage of the Affordable Care Act (ACA) in 2010, and the implementation of Medicaid expansions and Marketplaces in 2014, the U.S. significantly expanded access to health insurance coverage. Architects of the ACA rightly viewed Medicaid as an essential piece of the universal coverage puzzle. Indeed, Medicaid is a special piece of the coverage pie. This paper explains why it is essential for health coverage in the U.S. to maintain what makes Medicaid, Medicaid. For additional information about unique and important aspects of the Medicaid program, check out our entire What Makes Medicaid, Medicaid? series. And for a high-level overview of this paper, see our Highlights: What Makes Medicaid, Medicaid? factsheet. This series was originally published in 2015 and an archival copy can be found here.

  • June 7, 2022

    Medicaid, Child Welfare & Institutional Care: Qualified Residential Treatment Programs

    A landmark foster care reform law, the Family First Prevention Services Act, was intended to ensure that children are able to live in family-like settings and reduce reliance on unnecessary institutional care. In doing so, the new law put a spotlight on a longstanding Medicaid law and policy that prohibits states from obtaining federal funds for services provided to residents of mental health facilities with more than 16 beds. This exclusion has existed since Medicaid was enacted in 1965, and plays an oft misunderstood and underappreciated role in incentivizing states to provide services in smaller, more community-based settings. This issue brief discusses the intersection of the IMD exclusion with foster care placements and advocates for a path forward where federal funding continues to be used to further the goal of keeping children with families.

  • April 14, 2022

    NHeLP comments on Oregon’s application for renewal of the Oregon Health Plan § 1115(a) Demonstration Waiver for 2022-2027

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    In public comments, NHeLP expresses support for Oregon's decision to abandon its waiver of EPSDT. However, NHeLP strongly opposes Oregon's proposal to exclude outpatient prescription drugs approved under the FDA's accelerated approval pathway. Denying Medicaid enrollees access to effective break-through therapies would harm people with serious or life-threatening medical conditions. NHeLP also expresses concern about implementation of the EPSDT waiver withdrawal, and opposes the continued use of the prioritized list for children and adults.

  • January 6, 2022

    Section 1115 Waivers: Stop the Ten-Year Approvals

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    In 2017, the Centers for Medicare & Medicaid Services issued a policy announcing its intent to “approve the extension of routine, successful, non-complex” section 1115 waivers for a period of up to 10 years. Thereafter, CMS extended a number of projects for 10 years. This issue brief explains how the policy and the subsequent approvals are contrary to section 1115 and calls on the Biden administration to rescind the policy, reconsider the approvals, and adhere to the text of section 1115 moving forward.

  • November 30, 2021

    NHeLP Comments on Montana 1115 Waiver Request – IMD Exclusion

    Comments from the National Health Law Program opposing Montana's request for federal funding of mental health and SUD services in IMDs.

  • November 5, 2021

    NHeLP Comments on SUPPORT Act Section 1003 Demonstration

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    The Substance Use Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act requires the Department of Health and Human Services (HHS) to conduct a demonstration to increase the capacity of Medicaid providers to deliver substance use disorder (SUD) services. In comments to HHS, NHeLP urges the administration to ensure the demonstration centers beneficiaries in addition to providers; emphasizes availability or lack thereof of community-based services; surveys the harms of utilization management limitations on access to treatment for SUD; and evaluate compliance with EPSDT requirements. Finally, NHeLP calls on HHS to evaluate the impact of the projects on reducing health disparities.

  • November 1, 2021

    Comments: Utah Primary Care Network Extension Request

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    In comments to the Department of Health and Human Services, the National Health Law Program explains that the initial purpose of the Primary Care Network project, which started nearly 20 years ago as a way to expand coverage to population groups that were not described in the Medicaid Act at that time, has been lost. Currently, the project is a hodgepodge of features, many of which restrict coverage and access to care. As a result, we recommend that CMS take the following steps in response to Utah’s application: Where possible, CMS should require Utah to implement elements of the project through other authorities (the state plan or non-demonstration waiver authorities). CMS should then evaluate the remaining elements of the project in accordance with section 1115.

  • November 1, 2021

    Comments: New Hampshire Section 1115 Demonstration Amendment Request

    In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject New Hampshire's request to waive the Institutions for Mental Diseases (IMD) exclusion for certain psychiatric facilities.

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