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 New York.
  • Amicus: State of N.Y., et al. v. U.S. Dep’t Health & Human Servs., Southern District of New York

    Litigation Team

    National Health Law Program (NHeLP), Justice in Aging, and the Disability Rights Education and Defense Fund (DREDF) submitted an amicus brief in the Southern District of New York on behalf of themselves and 47 partners. The brief supports the State of New York and 22 other states’ motion for partial summary judgment against implementation of the Trump administration’s recently finalized rule to restrict the reach of Section 1557, the Affordable Care Act’s ground-breaking anti-discrimination provision. Our amicus argues that this Trump administration rule ignores the plain language of the ACA and is an arbitrary and capricious action by the administration. The 2020 changes to the 2016 Section 1557 rule include sharply limiting what entities must comply with Section 1557; eliminating notice, tagline, and effective communication requirements; and incorporating harmful exemptions from statutes not listed in the ACA, including religious exemptions. The Trump administration’s changes to the Section 1557 rule harm the very people that the ACA was intended to protect and removes critical protections that will impact millions of women, LGBTQ+ individuals, older adults, Black, Indigenous, and people of color (BIPOC), and individuals with limited English proficiency (LEP). The case in SDNY is one of several cases challenging the rule.

  • Due Process in Duals Demonstrations: A Closer Look at New York

    New York is one of several states working to better integrate care and services for individuals dually eligible for Medicare and Medicaid through a duals demonstration. In addition to integrating care, New York is working to integrate the Medicare and Medicaid appeals processes for individuals participating in its duals demonstration. This issue brief analyzes New York's integrated appeals process and examines the effects of integration on enrollees' due process rights.

  • Medicaid Payment for Benefits Decision: Davis v. Shah

    External Source

    UNITED STATES DISTRICT COURT WESTERN DISTRICT OF NEW YORK __________________________________________ HARRY DAVIS, et al., Plaintiffs -vs-   NIRAV SHAH, individually and in his official capacity as Commissioner of the New York State Department of Health, Defendant __________________________________________ APPEARANCES For Plaintiffs: Bryan D. Hetherington, Esq. Geoffrey A. Hale, Esq. Jonathan Feldman, Esq. Empire Justice Center One West Main Street, Suite 200 Rochester, New York 14614   Martha Jane Perkins, Esq. Sarah Jane Somers, Esq. National Health Law Program 101 E. Weaver Street, Suite G-7 Carrboro, North Carolina 27510 For Defendant: J. Richard Benitez, Esq. Office of the New York State Attorney General 144 Exchange Boulevard, Suite 200 Rochester, New York 14614   INTRODUCTION This is an action brought by Medicaid recipients to challenge New York State?s decision to provide Medicaid payment for prescription footwear and compression stockings for certain medical conditions but not others. Specifically, Plaintiffs challenge New York State Social Services Law § 365-a(2)(g)(iii), which provides Medicaid payment only for prescription footwear ? used as an integral part of a lower limb orthotic appliance, as part of a…

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