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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- February 27, 2017
Indiana expanded Medicaid through a demonstration waiver that some have lauded as a "potential model" for other states interested in expanding Medicaid. Senior Policy Analyst David Machledt, examining evaluations of Indiana's so-called Healthy Indiana Program, concludes that the state's Medicaid demonstration, so far, has generated plenty of confusion, but little evidence that it has improved access to health care services or produced healthy behaviors. (Updated May, 2019)
- February 9, 2017
More than 80 public interest groups urged the Senate to defeat the nomination of Rep. Tom Price (R-Ga.) to lead the U.S. Department of Health and Human Services (HHS). The groups' letter to the Senate notes that the mission of HHS is to "enhance and protect the health and well-being of all Americans." The groups continue, however, that Rep. Tom Price has a long record of advocating for policies that coddle corporations and the wealthy at the great expense of public safety net programs to help our nation's most vulnerable. The National Health Law Program (NHeLP) was among the groups to sign the letter. Others signing on include: the AFL-CIO, Community Catalyst, CREDO, Families USA, The Leadership Conference on Civil and Human Rights, MomsRising, NAACP, National Center for Lesbian Rights, National Immigration Law Center, and Planned Parenthood Federation of America.
- September 1, 2016
In comments to the U.S. Department of Health and Human Services, NHeLP Director of Health Policy Leonardo Cuello recommends that HHS should improve the Medicare and CHIP Reauthorization Act regulations to encourage models of care that will provide consumers with high-quality care, and put less emphasis only on increasing provider risk and reducing costs.
- August 24, 2016
Health Policy Director Leonardo Cuello provides updates on the states seeking to expand Medicaid pursuant to the Affordable Care Act, and examines the troubling deviations from Medicaid law that some states are pursuing. As Cuello notes in the August "Health Advocate," the U.S. Department of Health & Human Services (HHS) should never approve demonstration waivers "that reduce access to care for enrollees." Cuello writes that several states, such as Ohio, Kentucky, Arkansas and Utah are proposing waivers that if approved by HHS would greatly weaken Medicaid coverage for enrollees.
- August 19, 2016
In comments to U.S. Department of Health and Human Services Secretary Sylvia Burwell, NHeLP Director of Health Policy Leonardo Cuello urges HHS to reject Arkansas's proposed application for a Section 1115 demonstration waiver. Cuello notes that the "Arkansas Works Program" would, in part, undermine the state's expansion of Medicaid by requiring onerous premiums, and greatly restrict non-emergency medical transportation for enrollees. Cuello, moreover, calls on HHS to ensure that state health officials do not present a "work referral" in such a manner that "confuses enrollees into thinking it is a conditions of eligibility and/or otherwise dissuades enrollment in Medicaid."
- January 20, 2016
In comments to U.S. Department of Health and Human Services Secretary Sylvia Burwell, NHeLP Director of Health Policy Leonardo Cuello explains why HHS should reject Ohio's application for a Section 1115 demonstration waiver, stating that Ohio is seeking "numerous provisions unauthorized by any federal law and harmful to enrollees."
- August 12, 2015
This chart shows the major waivers requested and approved in section 1115 demonstrations to implement Medicaid expansion in the six states that have been approved for such demonstrations. (This chart was updated in August 2017.)
- April 16, 2015
Due to regulatory changes and guidance issued over the past year, states should have evaluated and likely changed their person-centered planning process for home and community-based services. This Q&A focuses less on the regulatory changes and more on the important features of the current requirements for person-centered planning and how these features should positively affect the experience of the participant.
- March 4, 2015
States reluctant to accept federal funds for the Affordable Care Act's adult Medicaid expansion have proposed health expense accounts as a mechanism to "brand" their expansion as different. These accounts add administrative complexity, cost, and likely impede beneficiaries' access to care. The Healthy Indiana Plan (HIP), implemented in 2008 and renewed with changes in 2015, was the first demonstration to deploy such a model. CMS has also approved different health expense accounts in Michigan and Arkansas. All these models, approved using the demonstration authority in § 1115 of the Social Security Act, include premiums and, in some cases, higher cost sharing on beneficiaries. This fact sheet provides a brief overview and highlights some of the key ramifications of this approach to Medicaid expansion. For a fuller discussion of health expense accounts, see NHeLP's Q & A on Health Expense Accounts in Medicaid.