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 Michigan.
  • Amicus: State of N.Y., et al. v. U.S. Dep’t Health & Human Servs., Southern District of New York

    Litigation Team

    National Health Law Program (NHeLP), Justice in Aging, and the Disability Rights Education and Defense Fund (DREDF) submitted an amicus brief in the Southern District of New York on behalf of themselves and 47 partners. The brief supports the State of New York and 22 other states’ motion for partial summary judgment against implementation of the Trump administration’s recently finalized rule to restrict the reach of Section 1557, the Affordable Care Act’s ground-breaking anti-discrimination provision. Our amicus argues that this Trump administration rule ignores the plain language of the ACA and is an arbitrary and capricious action by the administration. The 2020 changes to the 2016 Section 1557 rule include sharply limiting what entities must comply with Section 1557; eliminating notice, tagline, and effective communication requirements; and incorporating harmful exemptions from statutes not listed in the ACA, including religious exemptions. The Trump administration’s changes to the Section 1557 rule harm the very people that the ACA was intended to protect and removes critical protections that will impact millions of women, LGBTQ+ individuals, older adults, Black, Indigenous, and people of color (BIPOC), and individuals with limited English proficiency (LEP). The case in SDNY is one of several cases challenging the rule.

  • K.B. v. Michigan D.H.H.S., Eastern District of Michigan

    A class of Medicaid-eligible children with intensive mental health care needs who are at risk of avoidable psychiatric hospitalizations or commitment to the juvenile delinquency system sued the Michigan Department of Health and Human Services for failing to provide needed mental health services in the community as required by the Early and Periodic Screening, Diagnostic and Treatment and the Americans with Disabilities Act.

  • Comments to HHS on Michigan 1115 Waiver Project

    In comments to the U.S. Department of Health and Human Services, the National Health Law Program urges the department to reject Michigan’s Sec. 1115 Medicaid waiver application, because it would increase premiums and impose unlawful conditions of eligibility, including required healthy behavior and work-related activities. In previous comments to HHS, the National Health Law Program has detailed why even the existing premiums and cost sharing structure decrease enrollment and access to care and should not have been approved. Subsequent evidence has shown that the existing premiums and healthy behavior policies are increasing medical debt and depressing enrollment. The proposed changes will only exacerbate these problems. Additionally, the proposed changes do not comply with § 1115 of the Social Security Act, as they will block, rather than facilitate, access to Medicaid coverage.

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