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 Waivers and Demonstrations and Kentucky.
  • National Health Law Program: Comments to HHS on KY Sec. 1115 Waiver Project

    National Health Law Program in comments to the U.S. Department of Health and Human Services, again, urged the agency to reject Kentucky's proposed Medicaid waiver plan that was invalidated by a U.S. District Court in Stewart v. Azar. The Kentucky plan is again before HHS because the district court remanded it to the agency with direction to re-consider, within the bounds of Medicaid law, the legality of Kentucky's proposed plan. National Health Law Program again argues that the Kentucky waiver plan will lead to substantial numbers of individuals and families losing health care coverage, with many of them unable to meet the onerous requirements of Kentucky's work requirement. The work requirement's attempt at exempting "medically frail" individuals, data shows, will not do so adequately leaving many individuals with disabilities "more likely to lose benefits."

  • The Personal Stories of Those Affected by Kentucky’s Sec. 1115 Medicaid Waivers

    National Health Law Program Managing Attorney of the D.C. office Mara Youdelman details how Kentucky's Sec. 1115 Medicaid waivers program is harming the lives of the plaintiffs in the federal lawsuit challenging HHS's approval of the radical Medicaid waiver project, which includes an onerous work requirement and cuts to benefits, including retroactive eligibility.

  • Kentucky District Court Issues Good Medicaid and ADA Decision

    The Kentucky P&A has received an excellent decision in Michelle P v. Holsinger, No. 3:02-23-JMH (E.D. Ky. Feb. 11, 2005). The case involves Medicaid and ADA challenges to a home and community based waiver waiting list.   The court finds the following Medicaid provisions are enforceable pursuant to section 1393: 42 USC 1396a(a)(10)(A) (requiring eligibility); 1396a(a)(10) (B) (requiring comparability); 1396a(a)(8) (requiring reasonable promptness of assistance); 1396n(c)(2)(C) (requiring freedom of choice of institutional or home-based services). The Court applied the federal right enforcement test as "tweaked" by Gonzaga to find that each of these provisions has an unambiguous focus on the individual and contains sufficient rights-creating language.    The Court found the defendant's motion to dismiss the ADA claim was inappropriate for a 12(b)(6) motion: "ince the Plaintiffs do not seek the creation of new programs, whether the relief requested would result in a fundamental alternation 'is a matter that can be resolved only by a careful examination of the facts and circumstances....''" quoting Martin v. Taft, 222 F. Supp. 2d 940, 975 (S.D. Ohio 2002).

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