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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- District of Columbia
- New Hampshire
- New Mexico
- New York
- North Carolina
- July 18, 2019
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.
- March 7, 2016
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.
- May 14, 2014
Over 8 million people are now covered by health insurance thanks to open enrollment in the federal and state healthcare marketplaces. But, what about those who missed out on the open enrollment? In certain circumstances, such as loss of insurance coverage or other life changes, they may be eligible for coverage through special enrollment periods (SEPs).