This issue brief reviews the current status of states’ Section 1115 waiver requests relating to Medicaid work requirements and identifies key policy questions to consider in terms of the impact on beneficiaries, states, and other stakeholders.
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
- Don’t Expect Medicaid Work Requirements to Make a Big Difference
- 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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The proposed American Health Care Act (AHCA) includes a state option to make Medicaid eligibility for nondisabled, nonelderly, non-pregnant adults conditional upon satisfaction of a work requirement. Although the Centers for Medicare and Medicaid Services denied all state Section 1115 waiver requests to institute such work requirements under the Obama…
Medicaid Section 1115 Managed Long-Term Services and Supports Waivers: A Survey of Enrollment, Spending, and Program Policies
This report presents findings from a state survey about Medicaid Section 1115 capitated managed long-term care services and supports waiver enrollment, spending, and program policies for seniors and people with disabilities as of 2015.
While Congress continues to consider repeal and replacement of the Affordable Care Act (ACA) as well as fundamental changes to the structure and funding of the Medicaid program, states and the Administration may achieve major changes to Medicaid through the use of Section 1115 Medicaid waivers. In April, 2017, Maine and Wisconsin released for public comment at the state level proposed waivers that include many of these provisions. Unlike previous waivers that encompass the ACA’s Medicaid expansion, Wisconsin and Maine are seeking waiver authority to make significant changes to Medicaid that would affect non-expansion Medicaid populations.
Medicaid Waiver Requests in Wisconsin and Maine Seek to Impose Work Requirements and Time Limits for Beneficiaries
A new issue brief from the Kaiser Family Foundation highlights proposed changes to Medicaid programs in Wisconsin and Maine that include work requirements and time limits in both states, as well as drug screenings for some beneficiaries in Wisconsin. The waiver authority sought by both states would impose welfare-like restrictions…
In April 2017, as Indiana officials began roles in the Trump Administration’s health care leadership, the Foundation invited a group of journalists with a strong focus on health policy and state health reform to participate in a week-long fellowship focused on Indiana’s health care landscape and its approach to expanding…
This issue brief provides an overview of what Section 1115 Medicaid waivers are, how they are approved and financed, how states have used them, and how they are impacted by health reform. For many years, Section 1115 waivers have been used by states to test new coverage approaches not otherwise…
This fact sheet summarizes the Massachusetts health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)
This fact sheet compares and contrasts key provisions of the California and Texas Section 1115 Medicaid demonstration waivers. The Texas waiver, approved in December 2011, is modeled, in part, on the California waiver, which has been underway in that state since November 2010. Both waivers affect hundreds of thousands of…
With the recent governors’ elections in Kentucky and Louisiana refocusing attention on state Medicaid expansion decisions, a newly updated issue brief from the Kaiser Family Foundation provides an overview of the waivers obtained by six states – Arkansas, Iowa, Michigan, Indiana, New Hampshire and Montana — that are pursuing alternative Medicaid expansions under the Affordable Care Act.