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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- July 11, 2017
In comments to the U.S. Department of of Health and Human Services, NHeLP urges the HHS Secretary to reject Kentucky's proposed "HEALTH Program (KHP)," waiver. Kentucky's proposed waiver, which includes premiums, waiting periods and lockouts, and work service requirements, would apply to current beneficiaries, likely harming their coverage. The proposed exemptions to Medicaid would also limit attempts to enroll in the Medicaid program. "Kentucky itself projects that it its proposed amendments are approved, over 55,000 adults will lose coverage," NHeLP's comments state.
- July 10, 2017
As part of the NHeLP's "Protect Medicaid Webinar Series," Legal Director Jane Perkins and Cindy Mann, former director of the Center of Medicaid and CHIP Services at CMS, and now partner at Manatt, Phelps & Phillips, LLP, explored the scope of the Section 1115 demonstration waivers in Medicaid.
- July 10, 2017
In comments to the U.S. Department of of Health and Human Services, NHeLP urges Secretary Thomas Price to reject Indiana's amended extension to its so-called Healthy Indiana Plan 2.0 (HIP 2.0). Indiana's amended extension includes a program that diverts funds to a so-called "Gateway to Work" program that creates onerous obstacles for people trying to access health care. In its comments to Secretary Price, NHeLP states, "Work search requirements represent an illegal condition of eligibility beyond the Medicaid eligibility criteria." NHeLP adds, "A mandatory work requirement is not medical assistance; it is not a service provided to Medicaid beneficiaries." NHeLP previously filed comments raising objections to Indiana's initial version of its requested waiver extension. See this Issue Brief by Senior Policy Analyst David Machledt regarding Indiana's demonstration waiver request.
- April 29, 2017
A Quick Review of transparency and opportunity for public comment in requests for Section 1115 Waivers. In this brief overview, Senior Attorney Catherine McKee, Legal Director Jane Perkins, and Managing Attorney of the DC office Mara Youdelman note, "The importance of the transparency and public accountability requirements has never been greater," as the HHS secretary has expressed a willingness to approve demonstrations that include work requirements, eliminate presumptive eligibility, and impose greater premiums and cost-sharing than the Medicaid Act allows.
- April 21, 2017
With HHS Secretary Tom Price open to Section 1115 waivers in Medicaid that could include work requirements, state health advocates must be vigilant in ensuring waivers do not contravene Medicaid law. The Affordable Care Act (ACA) amended Sec. 1115 to require greater transparency and opportunity for public comment on proposed demonstration waivers considered by states and the Centers for Medicare & Medicaid Services (CMS). In this Issue Brief, Senior Attorney Catherine McKee and Legal Director Jane Perkins provide an in-depth look at the process for application, for approving Sec. 1115 waivers, requirements for monitoring approved waivers, and highlight steps advocates should take "to ensure that states and CMS consider the proposal's potential effects on Medicaid enrollees."
- April 4, 2017
In a companion piece to Background to Medicaid and Section 1115 of the Social Security Act, Legal Director Jane Perkins and Managing Attorney of the DC office Mara Youdelman provide a brief review of how certain Medicaid requirements may be waived. They conclude, in part, that "Section 1115 of the Social Security Act gives the Secretary of HHS limited authority to approve Medicaid waivers."
- April 3, 2017
Health and Human Services (HHS) Secretary Tom Price has signaled a willingness to allow states to reshape their Medicaid programs. In this issue brief, Legal Director Jane Perkins provides a background to Medicaid and Section 1115 of the Social Security Act to explain what HHS and the states are permitted to do in regards to providing Medicaid services. Perkins concludes that Section 1115 "allows states to test novel approaches to providing medical assistance," but does not allow HHS or the states to "ignore congressional mandates; to cut eligibility, services, or provider payments; or to use section 1115 to save money."
- March 21, 2017
Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why adding a work requirement to Medicaid is "legally suspect." They explain that currently the Medicaid Act has four requirements that an individual must meet that do not include a mandatory work requirement. "A number of courts," Perkins and McDonald write, "have recognized that states may not 'add additional requirements for Medicaid eligibility' that are not set forth in the Medicaid Act." They also note that the purpose of Medicaid is to "furnish medical assistance to low-income individuals who cannot afford the costs of medically necessary services and to furnish 'rehabilitation and other services to help attain or retain capability for independence or self-care. A mandatory work requirement is not medical assistance; it is not a service provided to Medicaid beneficiaries."
- March 21, 2017
In an effort to win conservative members' support for the Affordable Care Care Act repeal bill, House Republicans have added a work requirement for Medicaid to the measure. In this issue brief, NHeLP Managing Attorney of the DC office Mara Youdelman, Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why such work requirements "run counter to the purpose of Medicaid." They conclude, "Work requirements would stand Medicaid's purpose on its head by creating barriers to coverage and the pathway to health that the coverage represents."