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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- August 18, 2018
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."
- July 6, 2018
Centers for Medicare & Medicaid Services (CMS) should reject the Kentucky governor's "Alternative Benefit Plan (ABP) State Plan Amendment (SPA)," which took effect on July 1, according to the National Health Law Program, Kentucky Equal Justice Center and the Southern Poverty Law Center in a July 6 letter sent to Acting Director of CMS Timothy Hill. The groups are representing Kentuckians in a federal lawsuit challenging HHS's approval of Kentucky's Section 1115 waiver plan, which includes onerous restrictions on Medicaid services. On June 29, a federal court vacated and remanded the Kentucky waiver plan to the U.S. Department of Health and Human Services. In their July 6 letter to CMS, the groups argue that the Kentucky governor's application to cut vision, dental, and non-emergency medical transportation services is procedurally flawed, and therefore CMS must reject it and reverse the cuts to Medicaid services in Kentucky.
- June 13, 2018
What you need to know about June 15 oral argument in the federal class action lawsuit from Kentuckians challenging the Trump administration's approval of an onerous Medicaid waiver scheme that includes burdensome work requirements, high premiums, lock outs, and elimination of retroactive health care coverage. Read National Health Law Program's guide on what to expect from oral argument by Mara Youdelman and Jane Perkins.
- May 24, 2018
Representing children with disabilities, Disability Rights California, National Health Law Program and Western Center for Law and Poverty today filed a class action lawsuit in federal court against California's Medicaid agency (Medi-Cal) for failure to provide sufficient in-home nursing services. Medi-Cal's "deficient policies, practices, and procedures related to arrangement of in-home skilled nursing services violate not only ... provisions of the Medicaid Act, but also provisions of the Americans with Disabilities Act.
- May 15, 2018
The Secretary of the U.S. Department of Health and Human Services has maintained in Stewart v. Azar that nothing in the Medicaid Act limits his ability to waive portions of it, the National Health Law Program, Kentucky Equal Justice Center and the Southern Poverty Law Center state in their May 14 reply to the motions by HHS and the Kentucky government to dismiss the lawsuit challenging HHS's approval of Kentucky's Medicaid waiver project. "The Secretary's approval also rewrites the purposes of the Act to 'restructure' Medicaid into a work-oriented program aimed at teaching people about commercial insurance. Encouraging individuals to work may be a worthy policy goal, but it is manifestly not the goal of Medicaid, which Congress enacted to provide 'medical assistance' and 'rehabilitation and other services' to those individuals 'whose income and resources are insufficient to meet the costs of necessary medical services," the advocates' reply states.
- April 24, 2018
In comments to the U.S. Department of Health & Human Services (HHS), the National Health Law Program explains why Arizona's proposed Section 1115 Medicaid Waiver Amendment is flawed and legally suspect. Arizona's amended Medicaid waiver project includes an onerous work reporting requirement and lifetime limits on Medicaid. Work requirements are well-documented by extensive research that shows they do "little or nothing to increase stable, long-term employment and does not decrease poverty." Regarding Arizona's time-limit, the National Health Law Program notes, " Congress did not intend to limit Medicaid to temporary health care coverage. Instead, Congress designed Medicaid to furnish medical assistance to low-income individuals who cannot afford the costs of necessary medical care when and for long as they have a medical necessity for such assistance."
- April 11, 2018
A group of the nation's leading health law scholars is urging the U.S. District Court for the District of Columbia to reject federal approval of Kentucky's Medicaid waiver program in Stewart v. Azar. The health law scholars state in their friend-of-the court brief, that HHS's approval of Kentucky's Medicaid waiver project was outside the parameters of the Medicaid program, because "the waiver will reduce coverage, and with it, ongoing care. Even the state's own numbers show that rather than improving Medicaid, its actions will cull the rolls of both people who qualify for Medicaid as part of the ACA expansion as well as those eligible under traditional program rules." The scholars brief continues that Congress did not intend for Sec. 1115 waivers to be used to limit access to Medicaid. This so-called "demonstration" waiver, "destroys, not improves, Kentucky's substantial health care achievements and defeats, rather than promotes, Medicaid's purpose as a safety net insurer," the scholars' brief states.
- April 11, 2018
Justice In Aging, AARP Foundation, National Academy of Elder Law Attorneys, Disability Rights Education and Defense Fund urge the U.S. District Court for the District of Columbia in Stewart v. Azar to reject HHS's approval of Kentucky's waiver project that includes an onerous work requirements program, premiums, lock-outs, and other obstacles to Medicaid. "If implemented, the Kentucky Waiver will harm low-income persons with functional limitations and chronic conditions of all ages, but especially those ages 50 to 64. The results will be more low-income people without health care and without the ability to gain independence and provide self-care," the groups state in their friend-of-the-court brief.