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 Washington.
  • T.R. v. Dreyfus, U.S. District Court, Western District of Washington

    Litigation Team

    This class action lawsuit against the Washington State Department of Social and Health Services (DSHS) was brought on behalf of Medicaid-eligible children under age 21 in Washington State who were denied necessary intensive home and community-based mental health services. The lawsuit also claimed that the state has failed to comply with the American with Disabilities Act (ADA), which requires that public entities such as DSHS provide services to children with psychiatric disabilities in the most appropriate integrated setting.   In March 2012, the parties reached an Interim Agreement. The agreement suspended litigation while the State worked to build a framework for reform of the mental health system for children on Medicaid. Before the Interim Agreement expired, the parties negotiating a full settlement agreement. On September 27, 2013, the court granted preliminary approval of the proposed settlement, and on December 19, 2013, after a fairness hearing, granted final approval of the settlement.

  • Amicus: State of Washington v. U.S. Dep’t Health & Human Servs., Western District of Washington

    Litigation Team

    The National Health Law Program filed this brief, signed by 11 other organizations in support of the State of Washington’s efforts to enjoin the Administration’s changes to the rules for the ACA’s non-discrimination provision, Section 1557. The 2020 Revised Rule regarding section 1557 of the Patient Protection and Affordable Care Act will limit the anti-discrimination protections that are applied to all health insurers, including Medicaid and other Federal programs. The 2020 Revised Rule eliminated important protections against sex discrimination that will harm Lesbian, Gay, Bisexual, Transgender, Queer, Plus (“LGBTQ+”) individuals and women. It also eroded important notice and effective communication protections for people with limited English proficiency (LEP) and disabilities. And it erased whole categories of entities from coverage under Section 1557, including many private insurers and certain Federal programs.

  • Schmitt v. Kaiser Found. Health Plan Wash.: Amicus Brief

    In Schmitt v. Kaiser Found. Health Plan Wash., several Washington residents experiencing hearing loss challenge the exclusion of hearing aids from their health plans’ covered benefits. The plaintiffs claim such coverage exclusions are unlawful discrimination. In an appeal pending before the 9th Circuit, the National Health Law Program (NHeLP) and Northwest Health Law Advocates (NoHLA) filed an amicus brief in support of the plaintiffs. The amici describe how the Affordable Care Act and its key nondiscrimination provision, Section 1557, seek to end discriminatory practices by insurers, including discriminatory benefit design. Amici argue that the district court failed to consider methodologies developed by the US Department of Health and Human Services to evaluate plan benefit design.

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