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

search submit icon
results in Waivers and Demonstrations and National.
  • Key Takeaways for Medicaid Health Expense Accounts

    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.

  • Q&A: Health Expense Accounts in Medicaid

    In considering whether to accept federal funds for the Affordable Care Act's (ACA) adult Medicaid expansion, several states have turned to approaches that establish individual accounts for beneficiaries to manage their Medicaid expenses. The Healthy Indiana Plan (HIP), implemented in 2008 and renewed with changes in 2015, was the first demonstration to deploy such a model. Designed very loosely after Health Savings Accounts, HIP remains the only Medicaid program that couples a health expenses account with a high deductible insurance plan. CMS has approved two substantially different health expense account demonstrations in Michigan and Arkansas. All these models are closely tied to the imposition of premiums and, in some cases, higher cost sharing on beneficiaries. This Q & A reviews the differences between these models, explores the legal requirements that apply to Medicaid health expense accounts and explains some of the policy ramifications of this approach to Medicaid expansion. A summary of key takeaways from this report is also available.

  • MAGI, Streamlined Applications, and Medicaid Family Planning Expansions

    Erin Armstrong, External Source, and

    The Affordable Care Act (ACA) requires states implement a uniform methodology for determining income - modified adjusted gross income (MAGI) - in their eligibility determinations for Medicaid and for premium subsidies in the health insurance marketplaces. The ACA also requires states to move to a single, streamlined application (SSA), which the federal and state insurance marketplaces use to gather and assess information necessary to determine the insurance coverage and assistance for which a person is eligible. Consumer and provider groups have expressed concern about the impact of transitioning to MAGI and SSA on Medicaid family planning expansion programs. In recent months, representatives of NHeLP, NFPRHA, the Guttmacher Institute, NWLC, and PPFA met with representatives of the Centers for Medicare & Medicaid Services (CMS) to discuss these issues. This memo details the outcomes of those conversations with CMS regarding MAGI, SSA, and Medicaid family planning expansions.

  • Earlier Access to Care for Uninsured Women Living with HIV and the ACA

    The Medicaid program has traditionally served as an important safety-net program for low-income women living with HIV/AIDS; however, the categorical requirements for Medicaid have excluded many individuals from coverage. The Affordable Care Act, through the Medicaid Expansion, presents the opportunity for previously ineligible low-income women living with HIV to become eligible for Medicaid. Also, states have previously used §1115 demonstration projects to provide innovative approaches to care for this community. This analysis reviews how § 1115 demonstrations can effectively be used to develop innovative models of reducing transmission, provide early treatment, and reduce long-term disabilities for WLWH who currently reside in states not expanding Medicaid eligibility.

  • Health Advocate: Our New Year’s Resolutions

    This edition of the Health Advocate previews what is ahead in the coming months including the continuing theme of Medicaid expansion, protecting what makes Medicaid "Medicaid" as the new Congress gears up, and our work to protect and expand access to reproductive health and the courts.

  • NHeLP Matters – December 2014

    Welcome to the year's final edition of NHeLP Matters. In the past 12 months, we have fought for the health care rights of low-income people and individuals with disabilities in Washington and beyond. Learn more about our work advancing reproductive health, protecting Medicaid and bringing together advocates and policy makers across the nation to strategize on ways to improve health care.

  • NHeLP Comments on Amendments to Arkansas’s Health Care Independence Program

    Arkansas recently proposed amendments to its premium assistance Medicaid expansion demonstration, the Health Care Independence Program. These are NHeLP's comments to the proposed amendments, which include new premium and cost sharing provisions, limitations to nonemergency medical transportation, and a health care expenses account for premium assistance enrollees.

  • NHeLP Comments to Healthy Indiana Plan Renewal and Healthy Indiana Plan 2.0 Section 1115 Demonstration Applications

    Leo Cuello and

    Comments to HHS regarding Indiana's HIP and HIP 2.0 section 1115 demonstrations to implement the Medicaid expansion. NHeLP's comments focus on the need to implement Medicaid expansion without waivers that eliminate core Medicaid protections.

  • Q&A HCBS – Transition Plan Advocacy: Identifying the Issues

    This Q&A resource developed and written by NHeLP is for advocates working on, or considering, comments on State transition plans for Home and Community-Based Services (HCBS) programs. This document will help advocates: Identify changes needed in existing HCBS programs and the information within an organization that can be used to comment on transition plans for these programs; Understand the transition plan process and the connection to Olmstead advocacy; Develop inquiries by using the expertly crafted sample questions to ask when looking at a current HCBS program; Find compelling examples to demonstrate how current policies may not conform to the new standards in practice; and Identify the issue areas that may yield illustrations of current problems (e.g., services, housing or employment) as well as potential roadblocks that need to be addressed to ensure successful transition to more integrated services.

  • Medicaid Premiums and Cost Sharing

    This brief reviews the literature on the impact of premiums and cost sharing on enrollment, service utilization, and health status. It focuses particularly on how the research consensus fits with the flexibility Medicaid law gives states to establish premiums and cost sharing. It also highlights changes brought about by new cost sharing regulations and discusses the legal and policy ramifications of proposals by some states to charge Medicaid beneficiaries even higher cost sharing and premiums.

Load More