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 29, 2020
The COVID-19 pandemic has resulted in rapid and significant changes to the country’s health care system. State Medicaid programs, state insurance departments, and the federal government have responded in a variety of ways. This docket tracks state and federal litigation stemming from the COVID-19 response and relating to Medicaid, the Affordable Care Act, or other important health care protections.
- July 20, 2020
This publication identifies ten actions that advocates can take to maximize eligibility and enrollment in Medicaid during and after the COVID-19 emergency.
- July 20, 2020
NHeLP comments on Medicaid Prescrption Drug Rebate Program and Value- based Purchasing Proposed Rulemaking
In a proposed rule, CMS seeks to expand value-based purchasing arrangements for prescription drugs in commercial plans and the Medicaid program. However, the proposed changes offer a cost-containment strategy with no safeguards to ensure that Medicaid enrollees can continue to access needed outpatient prescription drugs. NHeLP comments warn against“cost effectiveness” measures which are discriminatory or lead to unlawful health care rationing, and urge CMS to withdraw the proposed rule.