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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- July 23, 2013
Recommendations for further study by the Continuity of Care Committee EXECUTIVE SUMMARY The Affordable Care Act (ACA) ushered in a new age of health care reform in the United States that will open up health insurance coverage for millions of people. The law provides for tax credits and cost sharing subsidies to assist low-income individuals and families between 100 and 400 percent of the Federal Poverty Level (FPL) in purchasing insurance through the Health Benefit Exchange. It codifies strong rules to prevent insurance companies from denying coverage to individuals with preexisting conditions, ensuring access to affordable and comprehensive coverage. The ACA also expands Medicaid by raising the income limit for parents up to 138 percent of the FPL and ? for the first time without a special waiver ? allowing states to cover childless adults at the same income limits as parents. The ACA determines eligibility for Medicaid and the Exchange principally on income. By definition, therefore, eligibility for these programs is sensitive to income fluctuations and changes in family composition. The result will be that a large number of individuals will move between Medicaid and the Exchange. This churning can impact…