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.
  • August 20, 2021

    NHeLP comments on Updating Payment Parameters Rule

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    In the Updating Payment Parameters Rule (UPP Rule), the Centers for Medicare & Medicaid Services proposes several important changes to enrollment in the Affordable Care Act (ACA) Marketplaces. These changes include extending the open enrollment period, establishing a year-around Special Enrollment Period for low income persons, restoring key features of the Navigator program such as providing consumers assistance in using their plans, ending the abortion double-billing provision, and restoring guard rails for Section 1332 waivers. NHeLP comments express strong support for these changes, and suggest areas where CMS can go even further to help consumers and reduce the number of insured people.

  • July 15, 2021

    Making Sure Medicaid is Ready for Public Health Emergencies

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    In 2020, the COVID-19 pandemic plunged the United States into a public health crisis. This situation was not entirely unprecedented. Local crises had previously been triggered by events such as hurricanes (e.g., Katrina in 2005, Irma in 2017), wildfires (e.g., California in 2017 and 2018), lead contamination (Flint, Michigan in 2016), and terrorist attacks (New York City after 9/11). During these events, the Secretary of the Department of Health and Human Services (HHS) used waiver authority to allow affected states to ignore otherwise mandatory Medicaid requirements so that they could use Medicaid as part of the emergency response. These crises, and particularly the COVID-19 pandemic, have made it clear that the current statutes do not give HHS sufficient emergency waiver authority. This paper: Outlines legal authorities that allow HHS and states to adjust their Medicaid programs during an emergency; Identifies deficiencies in these authorities; and Makes recommendations that, if implemented, will better prepare Medicaid programs for the next crisis. The two authorities that HHS and states have turned to the most during emergencies are Section 1115 and Section 1135 of the Social Security Act.

  • May 20, 2021

    Primer: State Plan Amendments v. Section 1115 Waivers

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    Tension and confusion can arise over how HHS allows states to change their Medicaid programs, whether through a state plan amendment (SPA) or a Section 1115 project. To help guard against the impoper use of Section 1115 waivers, advocates must know the distinctions between Section 1115 waivers and SPAs. This primer outlines these distinctions.

  • February 23, 2021

    NHeLP Comments to Interim Final Regulations on MOE

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    NHeLP comments to an Interim Final Regulation opposing HHS's attempt to weaken the Maintenance of Effort requirement protecting Medicaid coverage during the COVID-19 pandemic.

  • December 23, 2020

    Comments to Georgia 1332 Application

    NHeLP comments to GA 1332 application attempting to privatize Marketplace.

  • December 23, 2020

    Comments to 1332 Guidance (2018)

    Comments to 2018 CMS Guidance Weakening 1332 Standards.

  • December 14, 2020

    Sec. 1115 Waiver Tracking Chart

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    Sec. 1115 of the Social Security Act allows the Secretary of HHS to waive some requirements of the Medicaid Act so that states can test novel approaches to improving medical assistance for low-income people. While historically states have proposed waivers that did indeed propose innovative approaches to improve Medicaid and expand coverage, now, at HHS’s urging, several states are seeking waivers to impose harmful cuts and restrictions. The first set of harmful waivers have been approved for Kentucky, with a number of state’s poised to enact similar changes to Medicaid. This chart provides an overview of the harmful waiver provisions that have been proposed to-date. (Chart updated as of December 14, 2020)  

  • December 3, 2020

    NHeLP Comments on HHS Regulations Rule (aka SUNSET Rule)

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    In the Regulations Rule, HHS seeks to retroactively impose a mandatory expiration date on an estimated 18,000 duly promulgated regulations. Even long-standing rules would be automatically rescinded unless they survive a complex process of assessment and review. Programs like Medicaid and the Children's Health Insurance Program (CHIP) could be devastated if important regulations are arbitrarily rescinded. In comments, NHeLP pushes back against this unlawful and ill-conceived proposal designed to sabotage HHS safety net programs.

  • September 14, 2020

    NHeLP comments on HHS Proposed Rule on Guidance

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    Guidance documents are a valuable tool that allows agencies to clarify policy issues and explain ambiguities raised by the laws and rules they are tasked with implementing. Programs like Medicaid and the implementation of the Affordable Care Act depend heavily on guidance documents to clarify coverage requirements and the obligations of state programs serving low income communities. However, a HHS proposed “good guidance " rule would open the door to the administration repealing important guidance without notice or explanation, and would create a time-consuming and burdensome process to reinstate or implement new guidance. In these comments, NHeLP explains why the proposed "good guidance" rule would be, in fact, harmful, and urge HHS to withdraw the proposed rule.

  • July 20, 2020

    Top Ten List: Medicaid Eligibility & Enrollment in Light of COVID-19

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    This publication identifies ten actions that advocates can take to maximize eligibility and enrollment in Medicaid during and after the COVID-19 emergency.

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