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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- April 10, 2018
In comments to the U.S. Department of Health & Human Services (HHS), the National Health Law Program urges the Secretary to reject Mississippi' Sec. 1115 Medicaid waiver project, so-called "Medicaid Workforce Training Initiative." The state's waiver scheme imposes onerous work requirements, which stands "Medicaid's purpose on its head by creating barriers to coverage and the pathway to health that the coverage represents." This punitive policy would cover fewer people and increase the ranks of the uninsured. The National Health Law Program argues that Mississippi's program would, by design, leave individuals without access to Medicaid, or any affordable coverage option. Moreover, as Mississippi has not expanded Medicaid under the Affordable Care Act, the population most affected by the work requirements would be parents and caretakers.
- April 1, 2018
The Trump administration's approval of Kentucky's Medicaid waiver project with its onerous work requirements and other legally suspect obstacles to health care for low-income individuals violates Medicaid law because the administration has "effectively rewritten the Medicaid Act, bypassing congressional restrictions by regulatory fiat, overturning a half century of administrative practice, ignoring large swaths of social science evidence and data, and threatening irreparable harm to the health and welfare of tens of thousands of people," state National Health Law Program, Kentucky Equal Justice Center, and the Souther Poverty Law Center (SPLC) in their Memorandum In Support Of Motion For Summary Judgement in Stewart v. Azar. The health and human rights groups, representing more than a dozen Kentucky Medicaid beneficiaries, sued the Trump administration in January in federal court arguing that the approval of Kentucky's Medicaid wavier scheme was illegal, and must be rescinded.
- March 8, 2018
Work requirement programs in Medicaid are not only legally suspect, but they are nonsensical, undermining the intent of Medicaid - to provide health care to low-income individuals and families (so that they are able to find and keep work). The Trump administration is pushing states to add work requirements to their Medicaid programs. It recently approved Arkansas's Medicaid waiver program that includes a pernicious work requirement program that will undermine access to comprehensive reproductive health care for thousands of low-income people in the state. National Health Law Program's Candace Gibson and Rachel Holtzman in this fact sheet examine myriad ways the so-called "Arkansas Works" project will cut off women of color, low-income women and other underserved communities from vital reproductive health care. "For example," Gibson and Holtzman write, "a woman or a transgender man subjected to these provisions may not be able to receive a prescription for hormonal contraception or may not be able to receive contraceptive counseling from their providers because of the disruption in coverage these provisions will create."
- March 8, 2018
The "Arkansas Works," Medicaid waiver project approved by Trump's HHS, if implemented, will block thousands of low-income people living with disabilities in Arkansas from accessing Medicaid. National Health Law Program Senior Policy Analyst David Machledt explains how Arkansas's waiver scheme, which provides no "resources or initiatives for employment supports that facilitate work," will add to the obstacles that people living with disabilities face in accessing health care in Arkansas. "People with disabilities," Machledt writes, "will be among those most negatively affected by administrative snafus, inadequate notice, insufficient accommodations, and not enough employment supports to meet their needs."
- March 8, 2018
The so-called "Arkansas Works" Medicaid waiver scheme recently approved by Trump's HHS is not only legally suspect, but will disproportionally harm people of color who need health care the most -- these are groups of people who have long been discriminated against in the health care system. The National Health Law Program's Mara Youdelman and Rachel Holtzman explain how the Arkansas Medicaid work requirement will cut off Medicaid to women, Blacks, Hispanics, nonelderly Asians and Native Americans.
- March 6, 2018
On March 5, 2018 HHS approved a section 1115 waiver requested by Arkansas. The approved project is effectively a cut that will worsen or eliminate access to Medicaid for low-income individuals. This proposal will have a significant detrimental impact on people of color, women, and people with disabilities. This fact sheet describes that impact.
- March 6, 2018
On March 5, 2018 HHS approved a section 1115 waiver requested by Arkansas. The approved project is effectively a cut that will worsen or eliminate access to Medicaid for low-income individuals. This proposal will have a significant detrimental impact on people with disabilities. This fact sheet describes that impact.
- March 6, 2018
Trump's HHS is pushing states like Arkansas to alter their Medicaid programs in legally suspect ways, such as adding work requirement programs in order for low-income individuals and families to access health care. The Arkansas waiver project also locks people out if they are unable to document in specific ways their efforts to find and keep work. National Health Law Program Senior Policy Analyst David Machledt, writes in this fact sheet, that the Arkansas waiver scheme adds "a bundle of red-tape mandates," but fails to provide "no added resources to create new employment opportunities or increase support for job training, education, or affordable childcare."
- February 1, 2018
Earlier today, HHS approved a section 1115 waiver requested by Indiana. The approved project is effectively a cut that will worsen or eliminate access to Medicaid for low-income individuals. This proposal will have a significant, detrimental impact on low-income individuals, particularly women, seeking reproductive health care. This fact sheet describes that impact.