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.
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- October 16, 2019
NHeLP comments on Indiana’s Serious Mental Illness/Serious Emotional Disturbance Section 1115 Waiver Request
In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Indiana’s proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. HHS, however, does not have authority to grant the request to waive the IMD exclusion because Indiana has not proposed a genuine experiment, and the Secretary may only waive requirements of the federal Medicaid Act to conduct an experiment or test a novel approach to improve medical assistance for low-income individuals. Furthermore, Section 1115 only permits waiver of those requirements found in 42 U.S.C. § 1396a, and the IMD exclusion lies outside of 42 U.S.C. § 1396a. Last, the proposal risks diverting funds away from appropriate community-based services, undermining decades of progress towards increased community-integration.
- September 23, 2019
The Personal Stories of Those Affected by Indiana’s Section 1115 Waiver
Indiana began implementing Medicaid work requirements on January 1, 2019. On December 31, 2019, the State will begin suspending the coverage of individuals who have not met the work requirements. Indiana estimated that once fully implemented, the work requirements would result in roughly 24,000 individuals losing Medicaid coverage each year for failing to comply. Because Healthy Indiana 2.0 violates numerous provisions of federal law and will gravely harm tens of thousands of Indiana residents, the National Health Law Program (NHeLP) and co-counsel Indiana Legal Services filed a lawsuit challenging the approval. The lawsuit was filed on behalf of four individuals who currently obtain their health care through Medicaid and will suffer serious harms as a result of the HIP 2.0 extension. This resource discusses how HIP 2.0 has and will continue to affect the named plaintiffs.
- September 23, 2019
Complaint Rose v. Azar
Indiana residents enrolled in Medicaid filed a lawsuit against the Trump administration challenging its extension of a Section 1115 project (HIP 2.0) allowing the State to condition Medicaid eligibility on compliance with work requirements. The approval also permits Indiana to charge enrollees premiums; terminate coverage and prohibit re-enrollment in Medicaid for failure to pay; impose a lockout penalty for failure to complete the redetermination process on time; eliminate retroactive eligibility; and eliminate NEMT. These changes have caused and will continue to cause tens of thousands of low-income individuals to lose access to Medicaid coverage and services.
- September 23, 2019
Summary of Lawsuit Filed Against HHS Approval of Indiana’s “Healthy Indiana Plan 2.0” Waiver
On February 1, 2018, the U.S. Department of Health and Human Services (HHS) approved Indiana’s request to condition Medicaid coverage of needed health care on work requirements. The approval, which extended the “Healthy Indiana Plan 2.0” (HIP 2.0) project, also allows the State to require low-income enrollees to pay a monthly premium, to be locked-out of coverage for failing to pay or to complete certain paperwork, and to eliminate retroactive coverage and coverage of non-emergency medical transportation. Because HHS’s approval of the HIP 2.0 extension violates numerous provisions of law and will harm tens of thousands of individuals in Indiana, the National Health Law Program, joined by Indiana Legal Services and Jenner & Block, LLP, filed a lawsuit challenging it on September 23, 2019.
- June 16, 2014
NHeLP Comments to Health Indiana 1115 Demonstrations
These NHeLP comments to the State of Indiana address numerous legal problems with the states two proposed section 1115 demonstrations, one to expand Medicaid and one to renewal the current 1115 if the Medicaid expansion is denied. NHeLP comments identify problems such as illegal premiums, cost-sharing, and restrictions on benefits.
