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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For many years, Section 1115 waivers have been used in the Medicaid program to provide states an avenue to test and implement coverage approaches that do not meet federal program rules, but there have been longstanding concerns about the lack of public input and transparency in the waiver approval process.…Fact Sheet Read More
This brief provides and update of the health care and health policy environment in California, discussing the budgetary environment, implementation of the state’s “Bridge to Reform” Medicaid waiver, and efforts to prepare for coverage expansions and new coverage options in 2014 under the Affordable Care Act.Issue Brief Read More
This brief provides an overview of Section 1115 waiver authority, describes major provisions of waivers that extend coverage to childless adults, and identifies key issues and implications of these waivers looking forward to the Affordable Care Act and beyond.Issue Brief Read More
Medicaid is a jointly financed partnership between the federal government and states. The federal-state financing and administrative structure of Medicaid provides a framework of federal core requirements along with broad state options for program design and administration. This issue brief presents an overview of the current Medicaid program framework, with…Fact Sheet Read More
Health Affairs Article: Florida's Medicaid Reform: Informed Consumer Choice?Florida's Medicaid reform program aims to encourage consumer choice and market competition by giving health plans new authority to vary benefits and having enrollees choose among the different plans. However, about three in 10 enrollees were not aware that they needed to…Report Read More
Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS
This issue brief compares the financial alignment demonstrations for beneficiaries who are dually eligible for Medicare and Medicaid in states that have memoranda of understanding approved by the Centers for Medicare and Medicaid Services.Issue Brief Read More
This fact sheet provides insight into how a repeal of the Affordable Care Act (ACA) and changes in the financing structure would affect Medicaid, including the Medicaid expansion, and how a Trump administration could change Medicaid through administrative actions.Fact Sheet Read More
This new fact sheet examines key questions around the potential changes President-elect Donald Trump and the next Congress may seek to make in Medicaid, a program that covers 73 million people nationally. Depending on how it is structured, a repeal of the Affordable Care Act could reverse the expansion of…News Release Read More
Data Note: Data Do Not Support Relationship Between States’ Medicaid Expansion Status and Home and Community-Based Services Waiver Waiting Lists
Some policymakers have been discussing whether state choices to adopt the ACA’s Medicaid expansion come at the expense of providing Medicaid home and community-based services (HCBS) to seniors and people with disabilities. This data note analyzes Medicaid HCBS waiver waiting list data for 2014 and 2015 and concludes that there does not appear to be a relationship between a state’s Medicaid expansion status and changes in its HCBS waiver waiting list.Issue Brief Read More
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…Fact Sheet Read More