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

results in California.
  • Medi-Cal Telehealth Guidance During the COVID-19 Emergency

    The COVID-19 pandemic has highlighted the importance of telehealth in delivering critical health care when people are not able to receive health services and supplies in person. Consequently, the state is implementing many policy changes to make sure that Californians are receiving the health care they need. Fortunately, California already had a robust set of policies that advance telehealth for individuals with Medi-Cal, including the Medi-Cal Manual on Telehealth, which was updated in 2019. This fact sheet provides a review of existing Medi-Cal policies that facilitate telehealth delivery and coverage and new guidance issued as a result of the COVID-19 emergency in California.

  • Telehealth Guidance for California Private Plans During the COVID-19 Emergency

    In California, most private health coverage plans are regulated by one of two regulators. California’s Department of Managed Health Care (DMHC) licenses most fully-insured health maintenance organization (HMO) plans in California, including most Covered California plans, and many private individual, small, and large group plans. The DMHC also regulates Blue Cross and Blue Shield fully-insured preferred provider organization (PPO) products in the state. The California Department of Insurance (CDI) regulates most fully-insured PPO products in California, other than the Blue Shield and Blue Cross PPOs regulated by DMHC, which includes some Covered California plans as well as other private individual market, small-group, and large-group plans. Both regulators have instructed their health plans to allow enrollees to access services by telehealth during the COVID-19 emergency in California. Their guidance is described in more detail in this fact sheet.

  • An Advocate’s Guide to Medi-Cal Services

    California’s Medi-Cal program provides free or low-cost health care coverage to more than 14 million low-income adults, families with children, seniors, persons with disabilities, pregnant women, children in foster care, and former foster youth up to age 26. Medi-Cal, like other Medicaid programs, covers a wide range of health services which, taken together, are intended to provide a comprehensive package of health care services from infancy to end of life. To learn more about what services are covered and for an explanation of many of the important benefits available through Medi-Cal, please review our 2020 publication. An addendum, Accessing Medi-Cal Services During COVID-19 Pandemic, has been added to this guide (September 2020). The entire guide can be downloaded or individual chapters accessed below.

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