New Directions for Medicaid Section 1115 Waivers: Policy Implications of Recent Waiver ActivitySeventeen states have had comprehensive Section 1115 waivers approved since January 2001. This brief provides an overview of this recent waiver activity and reviews the implications for coverage and access to care.Policy Brief (.pdf)
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
- 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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This fact sheet provides a brief introduction to Section 1115 waivers in the Medicaid program and highlights policy issues related to recent waiver activity. Fact Sheet (.pdf)
The Impact of Medicaid Reductions in Oregon: Focus Group InsightsOregon is one state that has significantly restructured its Medicaid program, known as the Oregon Health Plan (OHP), in response to budget pressures. As part of these changes, it has implemented significant benefit reductions and increased premiums and cost sharing in…
This new fact sheet summarizes Tennessee’s proposed waiver amendment to its TennCare program, which was submitted to the federal government in September 2004.
Utah Section 1115 Waiver Fact Sheet (.pdf)
Oregon Section 1115 Waiver
Tennessee's New “Medically Necessary” Standard: Uncovering the Insured?This policy brief describes a new standard passed by Tennessee’s legislature for determining whether an item or service is “medically necessary” under the state’s Medicaid program, TennCare. The brief concludes with some questions regarding the implications of the new standard for the populations…
Federal Medicaid Waiver Financing: Issues for CaliforniaThis issue brief focuses on the potential fiscal implications of a section 1115 Medicaid waiver for California.Report (.pdf)
The Impact of Recent Changes in Health Care Coverage for Low-Income People: A First Look at the Research Following Changes in Oregon’s Medicaid Program
The Impact of Recent Changes in Health Care Coverage for Low-Income People: A First Look at the Research Following Changes in Oregon's Medicaid ProgramOregon recently restructured its Medicaid program through a Section 1115 waiver and other program changes, largely in response to particularly difficult state budget problems. This report summarizes…
Medicaid spending on home and community-based service (HCBS) waivers dominates spending on community-based long-term care services offered through the Medicaid program. This paper examines trends in HCBS waiver enrollment and spending in recent years. Report (.pdf)