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
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- April 10, 2014
The Pennsylvania 1115 Medicaid proposal is an extremely dangerous one. Under the guise of expanding Medicaid it would enact historic cuts to the state's Medicaid program. Second, it tries to waive core Medicaid requirements. Approval of this demonstration as requested would be a serious harm to Medicaid enrollees in PA and beyond.
- July 23, 2013
Pennsylvania District Court Issues Mixed Decision in Medicaid Dental Case The Middle District of Pennsylvania has issued an important opinion in a Medicaid dental case on cross-motions for summary judgment. This class action was filed on behalf of Medicaid recipients with disabilities to ensure prompt access to dental care. In Clark v. Richman, No. 4:00 CV-1306 (M.D. Pa. Oct. 8, 2003), the court held that: (1) Plaintiffs? claims could be brought under Section 1983, notwithstanding the Supreme Court?s decision in Gonzaga Univ. v. Doe, including: (a) plaintiffs' claim under 42 U.S.C. § 1396a(a)(10) for dental services; (b) plaintiffs' claim under 42 U.S.C. § 1396a(a)(8) for reasonable promptness; (c) plaintiffs' claim under the "equal access" provision, 42 U.S.C. § 1396a(a)(30)(A), for failure to pay adequate rates for dentists; and (d) plaintiffs' EPSDT claims under 42 U.S.C. §§ 1396a(a)(10), 1396a(a)(43); (2) Summary judgment should be entered for the defendant on plaintiffs' claims to an entitlement to dental services and to receive such services with reasonable promptness. The court ruled that the "medical assistance" to which recipients are entitled is merely payment for services. The entitlement is not to the services themselves. As long as some…