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 Waivers and Demonstrations and Utah.
  • Comments: Utah Primary Care Network Extension Request

    In comments to the Department of Health and Human Services, the National Health Law Program explains that the initial purpose of the Primary Care Network project, which started nearly 20 years ago as a way to expand coverage to population groups that were not described in the Medicaid Act at that time, has been lost. Currently, the project is a hodgepodge of features, many of which restrict coverage and access to care. As a result, we recommend that CMS take the following steps in response to Utah’s application: Where possible, CMS should require Utah to implement elements of the project through other authorities (the state plan or non-demonstration waiver authorities). CMS should then evaluate the remaining elements of the project in accordance with section 1115.

  • Comments on Utah 1115 Primary Care Network Demonstration Waiver Amendment Request: In Vitro Fertilization and Genetic Testing for Qualified Conditions

    In comments to the Department of Health and Human Services, the National Health Law Program asks HHS to reject Utah's proposal to restrict coverage of in vitro fertilization (IVF) services and preimplantation genetic diagnosis (PGD) for Medicaid-enrolled individuals who: (1) have been diagnosed by a physician as having a genetic trait associated with one of five specified conditions; and (2) intend to get pregnant with a partner who also has been diagnosed by a physician as having a genetic trait associated with the same condition. First, Utah's application does not contain a sufficient level of detail to allow for meaningful comment. Second, Utah’s proposal is not likely to assist in promoting the objectives of the Medicaid Act and does not propose an actual experiment. And finally, Utah’s proposal is at best arbitrary, and at worst motivated by the discriminatory motive of trying to avoid providing medical assistance to people with disabilities.

  • Utah 1115 IMD Demonstration Request Comment

    Utah has applied for an 1115 demonstration waiving the IMD exclusion for people with serious mental illnesses. NHeLP submitted a comment opposing the demonstration request.

  • Comments: Utah 1115 Demonstration Waiver Amendment

    In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Utah's proposed project, which would impose a number of unlawful conditions on coverage and access to care. Utah requested a number of restrictions, including: capping enrollment in the expansion population; imposing work requirements; charging premiums (and terminating coverage and imposing a lockout penalty for failure to pay); charging an amount higher than otherwise permitted for non-emergency use of the emergency room; eliminating hospital presumptive eligibility; imposing a lockout penalty for an "intentional program violation;" eliminating EPSDT for people ages 19 and 20; cutting services for parents; and ignoring various managed care protections. The comments explain why the proposed project does not comply with the requirements of § 1115 of the Social Security Act.

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