This brief assesses the extent to which recent Section 1115 waivers have helped reduce the number of uninsured people and finds that there has been a net gain in coverage of 426,329 people under recent waivers.Issue Paper (.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)
Cindy Mann, senior fellow of the Commission, testified to the Senate Subcommittee on Public Health of the Health, Education, Labor and Pensions Committee on how to sustain and expand health care coverage for low-income children and families, and disabled and elderly people in these challenging times.
Fact Sheet (.pdf)
Fact Sheet (.pdf)
The Financing of Pharmacy Plus Waivers: Trade Offs Between Expanding Rx Coverage and Global Caps in Medicaid
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.
This issue paper examines the policies in the HIFA waiver initiative that provide incentives for states to use Medicaid/SCHIP funds to assist in the purchase of private insurance options. It also reports on how states have responded to these new policies and what key policy questions are raised about premium…
A Case Study of the Utah Primary Care Network Waiver: Insights into Its Development, Design, and Implementation
This report examines the creation and implementation of Utah’s waiver through interviews with key stakeholders and an analysis of state enrollment data and quarterly reports. Also see Health Affairs article, Can States Stretch the Medicaid Dollar Without Passing the Buck? Lessons from UtahReport (.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…