Fact Sheet: Legal Issues in Section 1115 Medicaid Waivers

Executive Summary

Section 1115 waivers have been used over the history of the Medicaid program to implement demonstration projects designed to improve the delivery of medical assistance to low-income people. Over the last year, the Trump administration and a handful of states have begun to use Section 1115 in an effort to restructure Medicaid.

The National Health Law Program has worked with Section 1115 Medicaid waivers for over two decades. This fact sheet uses a Frequently Asked Questions format and includes a summary of the recently announced decision in Stewart v. Azar, vacating the administration’s approval of a Section 1115 project in Kentucky. It concludes with recommendations for ensuring that Section 1115 waivers are implemented in the “best interests of the recipients.”