Utah Section 1115 Waiver Fact Sheet (.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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Oregon Section 1115 Waiver
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)
A few recent state Medicaid initiatives have emerged that take the program into new directions. States have expressed a number of objectives in developing these approaches, including offering beneficiaries greater choice, promoting personal responsibility and healthier behaviors among enrollees, and, in some cases, relying more heavily on the private marketplace.…
The Vermont Choices for Care Long-Term Care Plan: Key Program Changes and QuestionsThis fact sheet summarizes Vermont’s Section 1115 waiver to make fundamental changes to its Medicaid program that provides long-term services and supports to eligible, low-income state residents. The waiver was designed to increase access to home and community-based…
This new fact sheet summarizes Tennessee’s proposed waiver amendment to its TennCare program, which was submitted to the federal government in September 2004.
Premium Assistance in Medicaid and CHIP: An Overview of Current Options and Implications of the Affordable Care Act
Premium assistance is the use of public funds through Medicaid or the Children’s Health Insurance Program (CHIP) to purchase private coverage. States have pursued premium assistance with varied objectives, including covering parents not otherwise eligible for public coverage and promoting the use of private coverage. Implementation of the Affordable Care…
For many years, Section 1115 waivers have been used in the Medicaid program, and to a lesser degree in the Children’s Health Insurance Program, to provide states an avenue to test and implement coverage approaches that do not meet federal program rules. While these waivers have facilitated important program evolutions…
This issue brief provides an overview of California’s “Bridge to Reform” Medicaid Demonstration Waiver, which was approved in 2010 and will make up to roughly $8 billion in federal Medicaid matching funds available to California over a five-year period to expand coverage to low-income uninsured adults and preserve and improve…
Washington’s Managed FFS Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries
Washington is the first state to sign a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test a managed fee-for-service (FFS) financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, beginning on April 1, 2013. Washington’s managed FFS demonstration uses…