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 Tennessee.
  • If Tennessee Does Not Expand Medicaid, It Could Cost Tennessee Businesses

    External Source

    The U.S. Supreme Court ruled in June that the Affordable Care Act (ACA) permits, rather than requires, states to expand Medicaid eligibility up to 138 percent of the federal poverty line (FPL). Now, Tennessee must choose whether to expand Medicaid. If Tennessee chooses not to expand Medicaid, it will cost some Tennessee businesses hundreds of thousands of dollars in additional federal taxes after 2014. Here?s how. The ACA calls for the creation of a competitive health insurance marketplace (sometimes called an ?exchange?) in every state by 2014. The exchange is required to have an easy-to-use website that allows consumers to make applesto-apples comparisons when they shop for health insurance. In the exchange, certain consumers with incomes between 100 and 400 percent of the federal poverty level will be eligible for premium tax credits to help them pay their insurance premiums. The ACA does not require businesses to provide health insurance to their workers. Starting in 2014, however, employers with at least 50 full-time employees  will face tax penalties if they do not offer affordable insurance to their employees and one or more full-time employees receive a premium tax credit on the exchange. The ACA was designed with the expectation…

  • Medicaid Expansion in Tennessee Will Produce Additional Revenues That Will More

    External Source

    The Supreme Court ruled in June that the new health reform law permits, rather than requires, states to expand their Medicaid programs to cover people with incomes up to 138 percent of the federal poverty line. Now, Tennessee must choose whether to expand Medicaid (TennCare). Some have argued that Medicaid expansion is too expensive. In fact, Medicaid expansion will not significantly increase costs for the state and will generate significant new tax revenues that will offset much or all of any additional costs through 2020.   Tennessee requires all health maintenance organizations (HMOs) doing business in Tennessee to pay a 5.5% tax on all premium dollars collected from or on behalf of enrollees. Because all Medicaid enrollees in Tennessee are enrolled in HMOs (generally called Managed Care Organizations, or MCOs, in the TennCare context), Tennessee receives tax payments from TennCare MCOs from the premiums they collect on behalf of TennCare enrollees. If Tennessee decides to expand Medicaid, the federal government will pick up all of the cost of the expansion for the first three years (2014-2016). Depending on the number of newly eligible individuals who enroll in the first three years, this could bring between $1.5…

  • Medicaid Expansion in Tennessee Will Produce Additional Revenues That Will More

    External Source

    The Supreme Court ruled in June that the new health reform law permits, rather than requires, states to expand their Medicaid programs to cover people with incomes up to 138 percent of the federal poverty line. Now, Tennessee must choose whether to expand Medicaid (TennCare). Some have argued that Medicaid expansion is too expensive. In fact, Medicaid expansion will not significantly increase costs for the state and will generate significant new tax revenues that will offset much or all of any additional costs through 2020.   Tennessee requires all health maintenance organizations (HMOs) doing business in Tennessee to pay a 5.5% tax on all premium dollars collected from or on behalf of enrollees. Because all Medicaid enrollees in Tennessee are enrolled in HMOs (generally called Managed Care Organizations, or MCOs, in the TennCare context), Tennessee receives tax payments from TennCare MCOs from the premiums they collect on behalf of TennCare enrollees. If Tennessee decides to expand Medicaid, the federal government will pick up all of the cost of the expansion for the first three years (2014-2016). Depending on the number of newly eligible individuals who enroll in the first three years, this could bring between $1.5…

Load More