Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states considerable flexibility in how they operate their programs, beyond what is available under current law, and can have a significant impact on program financing. As such, waivers have important implications for beneficiaries, providers, and states. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS). Looking ahead, states are likely to continue to request waivers to implement provisions not allowed under current law. The Trump administration recently signaled in a letter to governors that CMS would be open to considering waiver requests concerning work requirements in Medicaid, for instance, and some states may wish to experiment with premiums and cost-sharing requirements. This page highlights key resources examining Section 1115 waivers and, farther down, also provides the standard search result page for a site-wide search on the “waivers” tag.
Featured Waivers Resources
This issue brief focuses on Section 1115 waivers that implement the ACA’s Medicaid expansion and highlights themes in approved, pending, and denied provisions to date as well as key issues to watch looking ahead. Additional detail about each state’s waiver is provided in the Appendix tables.
Seven states (Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, and New Hampshire) currently are implementing the ACA’s Medicaid expansion through a Section 1115 demonstration waiver. The previous Administration denied Ohio’s waiver application. Two states (Kentucky and Indiana) currently have Medicaid expansion waivers pending before the Centers for Medicare and Medicaid Services (CMS).
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Related Waivers Resources
- Medicaid Waiver Requests in Wisconsin and Maine Seek to Impose Work Requirements and Time Limits for Beneficiaries
- 3 Key Questions: Section 1115 Medicaid Demonstration Waivers
- An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana
- Proposed Changes to Medicaid Expansion in Kentucky
- Medicaid Expansion Waivers: What Will We Learn?
- CMS’s Denial of Proposed Changes to Medicaid Expansion in Ohio
- Medicaid Non-Emergency Medical Transportation: Overview and Key Issues in Medicaid Expansion Waivers
- Medicaid Premium Assistance Programs: What Information is Available About Benefit and Cost-Sharing Wrap-Around Coverage?
- A Look at the Private Option in Arkansas
- Medicaid Section 1115 Managed Long-Term Services and Supports Waivers: A Survey of Enrollment, Spending, and Program Policies
- Key Themes From Delivery System Reform Incentive Payment (DSRIP) Waivers in 4 States
- An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers
- Michigan’s Medicaid Section 1115 Waiver to Address Effects of Lead Exposure in Flint
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Vermont’s Choices for Care Medicaid Long-Term Services Waiver: Progress and Challenges As the Program Concluded Its Third Year
Vermont's Choices for Care experiment in long-term services, created through a five-year Medicaid waiver in 2005, was designed to increase access to home and community-based services while reducing the use of institutional services and controlling overall costs. In exchange for agreeing to a federal funding cap, Vermont was able to…Report Read More
A new policy brief provides a description of the Section 1115 law, its history, and an overview of how it plays a role in the restructuring of Medicaid and SCHIP.Issue Brief Read More
A new report describes past waiver activity, the principles of the new HIFA initiative, and related policy implications. Background Paper Appendix: Side-by-Side ComparisonReport Read More
Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries
This paper provides an overview of the joint efforts of states and the Centers for Medicare and Medicaid Services (CMS) to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. Dual eligible beneficiaries…Issue Brief Read More
This issue brief focuses on one subset of “flexibility” issues: the current federal benefits and cost-sharing rules that apply with respect to acute care. Issue Paper (.pdf)Issue Brief Read More
This analysis finds that recent waivers have expanded coverage in important ways in a few states, but, overall, the number of people who have gained new coverage under recent waivers has been quite limited, well below projections and small compared to overall growth in Medicaid enrollment.Issue Paper (.pdf)Issue Brief Read More
Louisiana’s Proposed Section 1115 Medicaid Demonstration Project: Estimating the Numbers of Uninsured and Projected Medicaid Costs
This brief analyzes the composition and medical costs of the uninsured in Louisiana after Hurricane Katrina. The estimates in the brief are the first available that are based on a detailed analysis of who the uninsured are in Louisiana, their current medical spending, and what their spending might be under…Issue Brief Read More
This fact sheet describes Pennsylvania’s approved 1115 waiver demonstration, Healthy PA, which will implement the ACA’s Medicaid expansion.Fact Sheet Read More
This issue brief analyzes key themes in 19 capitated § 1115 and § 1915(b)/(c) Medicaid managed long-term services and supports (MLTSS) waivers approved to date by the Centers for Medicare and Medicaid Services (CMS) with a focus on covered populations and services, provisions aimed at expanding beneficiary access to HCBS, beneficiary protections, and quality measurement and oversight.Issue Brief Read More