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
- Show all
- District of Columbia
- New Hampshire
- New Mexico
- New York
- North Carolina
- July 23, 2013
The federal district court for Massachusetts has allowed a number of Medicaid claims for dental services made by an organization and beneficiaries to proceed to trial. Health Care for All, Inc. V. Romney, No. 00-10833-RWZ (D. Mass. Oct. 1, 2004). The court held that a number of crucial statutory provisions were enforceable under Section 1983 including: (1) the right to receive care with ?reasonable promptness;? (2) the right to care in equal ?amount, duration and scope;? and (3) benefits under Medicaid?s Early and Periodic Screening, Diagnosis and Treatment program. The court also held that the Medicaid provision requiring rates sufficient to attract adequate numbers of providers was not enforceable. In addition, the court held that the definition of EPSDT benefits was not enforceable, but allowed EPSDT claims to go forward under another statutory provision. As of October 18, the case is being tried. Counsel are Greater Boston Legal Services and Health Law Advocates. In Ohio, the District Court ruled that Medicaid claims brought on behalf of two children with multiple disabilities were enforceable, however, it dismissed the Medicaid claims on other grounds. A.M.H. v. Hayes, No. C2-03-778 (S.D. Ohio 2004). The court held that the…