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 Waivers and Demonstrations and National.
  • NHeLP Comments on Massachusetts’ Amended Sec. 1115 Waiver Project

    In comments to the U.S. Department of of Health and Human Services (HHS), NHeLP urges it to reject Massachusetts' Section 1115 waiver project because the state proposes changes to Medicaid that would undermine the purpose of the law and harm low-income people who need Medicaid for health care. Massachusetts seeks to waive requirements to shift costs to the federal government and reduce benefits and access to care for critical services without a clear experimental purpose. Additionally, number of the state's proposals lack key details that make it impossible for the public to evaluate the state's proposed changes, while others fall outside the legal scope of 1115 authority.

  • NHeLP Comments to HHS on New Hampshire’s Amended Medicaid Waiver Project

    In comments to the U.S. Department of of Health and Human Services (HHS), NHeLP urges it to reject New Hampshire's amended Section 1115 waiver project because the state proposes changes to Medicaid that would undermine the purpose of the law and harm low-income and underserved people who need Medicaid for health care. New Hampshire's amended waiver project includes a so-called "work requirement," that are an "illegal condition of eligibility ...," and have never been approved by HHS. "Conditioning Medicaid eligibility on completion of work activities gets it exactly backwards by blocking access to care and services that help individuals be able to work," NHeLP's HHS comments state.

  • NHeLP Comments on Utah’s Sec. 1115 Waiver Project

    In comments to the U.S. Department of of Health and Human Services (HHS), NHeLP urges it to reject proposed amendments to Utah's Primary Care Network (PCN) project. While NHeLP supports the use of Section 1115 waivers to implement experiments to improve health outcomes, we strongly object to any efforts to use Sec. 1115 to skirt essential provisions that Congress has placed in the Medicaid Act to protect Medicaid beneficiaries and ensure that the program operates in the best interests of the population groups described in the Act. Utah?s proposals to impose work requirements, place time limits on Medicaid coverage, cap enrollment in certain population groups, charge higher co-payments for non-emergency use of the emergency rooms, eliminate hospital presumptive eligibility, and eliminate EPSDT for individuals ages 19 and 20 should be rejected, separately and together, as they are inconsistent with the provisions of Sec. 1115.

  • NHeLP Comments on Massachusetts’ Sec. 1115 Waiver Project

    In comments to the U.S. Department of of Health and Human Services (HHS), NHeLP urges it to reject Massachusetts' Section 1115 waiver project because the state proposes changes to Medicaid that would undermine the purpose of law and harm low-income people who need Medicaid for health care. Massachusetts seeks to waive the requirement to cover non-emergency medical transportation (NEMT) for non-disabled adults in its MassHealth population and end provisional income eligibility. NHeLP argues that the "state does not provide meaningful evidence to justify this waiver of this important Medicaid benefit, which is specifically aimed at reducing important barriers to care for low-income populations. That is, NEMT is one of various benefits that tailors Medicaid coverage to meet the unique needs of low-income populations, which is why it should differ from commercial insurance."

  • NHeLP Comments on Maine’s Sec. 1115 Waiver Project

    In comments to the U.S. Department of of Health and Human Services (HHS), NHeLP urges it to reject Maine's Section 1115 waiver project because the state proposes changes to Medicaid that would undermine the purpose of law and harm low-income people who need Medicaid for health care. Maine's Sec. 1115 waiver application, for instance includes imposing work requirements, premiums, emergency department copyaments, and elimination of retroactive eligibility. NHeLP strongly objects to "any efforts to use Section 1115 to skirt essential provisions that Congress has placed in the Medicaid Act protect Medicaid beneficiaries and ensure that the program operates in the best interests of the population groups it is designed to protect."

  • NHeLP Comments on Iowa’s Amended Sec. 1115 Waiver Project

    In comments to the U.S. Department of of Health and Human Services (HHS), NHeLP urges the department to reject  Iowa's amended Sec. 1115 Medicaid waiver demonstration project because it flawed in procedure and would flout Medicaid law. For example, Iowa's amended Medicaid waiver project intends to rescind retroactive eligibility across Iowa's Medicaid population, including children, people with disabilities, and older adults. NHeLP says Iowa's "proposal erodes important protections for low-income populations without advancing any reasonable policy goals likely to promote the objectives of the Medicaid program. Section 1115 limits demonstration project to innovations that are likely to promote the objectives of the Medicaid program."

  • NHeLP Comments on Arkansas’ Amended Sec. 1115 Waiver Project

    In comments to the U.S. Department of of Health and Human Services (HHS), NHeLP urges the department to reject Arkansas' amended Sec. 1115 Medicaid waiver demonstration project because it is procedurally and substantively flawed and would flout Medicaid law. For example, Arkansas seeks to impose a work requirement on enrollment in the state's Medicaid program. NHeLP notes that under Sec. 1115, "HHS has no authority to approve any waiver permitting Arkansas to condition Medicaid eligibility on compliance with work activities (and, thus, has never done do)."

  • NHeLP Comments on Kentucky’s Modified Sec. 1115 Waiver

    In comments to the U.S. Department of of Health and Human Services, NHeLP urges the department to reject Kentucky's modified application for a Sec. 1115 demonstration waiver project. NHeLP's comments incorporate its comments to the Kentucky's initial waiver application. Kentucky's modified waiver application seeks the ability to impose work requirements on Medicaid beneficiaries and to level "lock-out" penalties on "individuals who do not timely report changes in income or employment ...." NHeLP concludes in its comments that Kentucky's "modifications only exacerbate the problems with the initial application, and as a result, should not be approved."

  • NHeLP Comments on ‘Healthy Texas Women’ Sec. 1115 Waiver Project

    In comments to the U.S. Department of Health and Human Services, NHeLP urges the department to reject Texas' so-called "Healthy Texas Women" Medicaid demonstration waiver. The comments submitted by NHeLP Legal Director Jane Perkins note that HHS has limited ability to waive provisions of Medicaid law. HHS "may only approve an application that proposes an experiment, pilot, or demonstration that is likely to promote the objectives of the Medicaid Act." Texas' application is seeking to waive parts of Medicaid law that would flout its purpose. The Texas application seeks to make it increasingly difficult for low-income women to access family planning and other preventive services. "The evidence from Texas is overwhelmingly clear - prohibiting low-income women from receiving family planning services from qualified providers of their choice because those perform or promote abortion reduces access to health care and places women's health at risk."

  • NHeLP Comments on Wisconsin’s Request to Amend its Sec. 1115 Waiver Project

    In comments to the U.S. Department of of Health and Human Services, NHeLP urges the department to reject Wisconsin's proposal to amend its Sec. 1115 "BadgerCare" demonstration project. The state's amended application process is flawed in process and substance. On substance NHeLP warns HHS that Wisconsin's request to condition Medicaid enrollment on work requirements and passing mandatory drug testing is illegal pursuant to Medicaid law. "Work requirements are an illegal condition of eligibility beyond the Medicaid eligibility criteria clearly enumerated in federal law," NHeLP's comments state.  NHeLP says Wisconsin's request to require mandatory drug testing as a condition of Medicaid eligibility is an "unprecedented proposal," that would interfere with the doctor-patient relationship, create barriers to and use of health care services

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