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 District of Columbia.
  • Amicus: State of N.Y., et al. v. U.S. Dep’t Health & Human Servs., Southern District of New York

    Litigation Team

    National Health Law Program (NHeLP), Justice in Aging, and the Disability Rights Education and Defense Fund (DREDF) submitted an amicus brief in the Southern District of New York on behalf of themselves and 47 partners. The brief supports the State of New York and 22 other states’ motion for partial summary judgment against implementation of the Trump administration’s recently finalized rule to restrict the reach of Section 1557, the Affordable Care Act’s ground-breaking anti-discrimination provision. Our amicus argues that this Trump administration rule ignores the plain language of the ACA and is an arbitrary and capricious action by the administration. The 2020 changes to the 2016 Section 1557 rule include sharply limiting what entities must comply with Section 1557; eliminating notice, tagline, and effective communication requirements; and incorporating harmful exemptions from statutes not listed in the ACA, including religious exemptions. The Trump administration’s changes to the Section 1557 rule harm the very people that the ACA was intended to protect and removes critical protections that will impact millions of women, LGBTQ+ individuals, older adults, Black, Indigenous, and people of color (BIPOC), and individuals with limited English proficiency (LEP). The case in SDNY is one of several cases challenging the rule.

  • National Health Law Program Comments on D.C. 1115 Waiver Application

    In comments to the Department of Health and Human Services (HHS), The National Health Law Program urges HHS to reject the District of Columbia’s proposed Section 1115 Medicaid Behavioral Health Transformation Demonstration Program. As part of the demonstration, the District seeks to waive the Institutions for Mental Diseases (IMD) exclusion and to improve the availability of other SMI/SUD services. HHS, however, does not have authority to grant the request to waive the IMD exclusion because the exclusion is found outside of 42 U.S.C. § 1396a and because waiving the exclusion does not constitute an experiment for purposes of Section 1115. Moreover, most of the additional changes the District seeks, including the addition of certain mental health and SUD services, may be achieved through submission of a State Plan Amendment (SPA), rendering the Section 1115 demonstration unnecessary. Because the demonstration fails to comply with Section 1115's requirements, HHS should deny the District's request. 

  • NHeLP Comments to the Senate Finance Committee on the High Price of Prescription

    NHeLP letter to the Senate Finance Committee in response to the request for public comment on policy issues including the financial impact of high prices of breakthrough drugs, data on prescription drug costs, and ensuring patient access, particularly for low income and vulnerable populations. Commments follow after an 18 month investigation into Gilead and the pricing of breakthrough treatments for hepatitis C, including Sovaldi and Harvoni.

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