Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State
This page aggregates tracking information on pending and approved Section 1115 Medicaid waivers. Scroll down or click on the links below to jump to resources such as an overview map and figure, detailed waiver topic tables, and explanatory briefs.
Landscape of Approved vs. Pending Section 1115 Medicaid Demonstration Waivers, December 7, 2018
Tracker contents:
- Detailed Topic Tables:
- Map: All Approved and Pending Waivers by Topic
- State Tables:
- Definitions and Other Notes
- Related Briefs and Resources
1. Populations, exemptions, penalties or consequences, and other details vary significantly by waiver.
2. Other groups such as Transitional Medical Assistance, family planning only, or former foster care youth, may be included in some states.
3. On November 20, 2018, CMS reapproved the Kentucky HEALTH waiver, including all of the provisions set aside in a previous decision issued by the DC federal district court in Stewart v. Azar, with minor technical changes. On June 29, 2018, the court set aside the Kentucky HEALTH waiver approval and sent the waiver back to HHS to reconsider the following provisions: the work requirement, monthly premiums up to 4% of income, coverage lockouts for failure to timely renew eligibility or timely report a change in circumstances, heightened cost-sharing for non-emergency ER use, and elimination of retroactive eligibility and non-emergency medical transportation. The separate “institution for mental disease” substance use disorder payment waiver was not set aside and was allowed to go into effect.
4. For non-exempt parents or caretakers whose incomes exceed the eligibility threshold as a result of meeting the work requirement, but who continue to fulfill the requirement, Mississippi would extend Medicaid coverage for a 12-month transitional medical assistance period. These beneficiaries would then qualify for an additional 12 months of coverage contingent upon continued work/community engagement participation.
5. For non-exempt parents or caretakers whose incomes exceed the eligibility threshold as a result of meeting the work requirement, but who continue to fulfill the requirement, South Dakota would extend Medicaid coverage for a 12-month transitional medical benefits (TMB) period. These beneficiaries would then qualify for an additional 12 months of premium assistance (limited to no more than the previous year’s TMB per member per month amount) to pay for employer-sponsored insurance or qualified health plan premiums. Beneficiaries would be responsible for cost sharing and any premium costs exceeding the TMB amount during the premium assistance period.
6. If approved by CMS, Utah’s Medicaid expansion will consist of an enhanced federal match for childless adults up to 100% FPL and adults with dependents between 60-100% FPL. Individuals subject to the work requirement provision would be required to complete participation requirements within three months of the demonstration’s approval in order to maintain eligibility for the remainder of their 12-month eligibility period. They must continue to meet such requirements every 12 months to continue to receive Medicaid benefits.
SOURCE: KFF analysis of approved and pending waiver applications posted on Medicaid.gov.
Waivers with Eligibility and Enrollment Restrictions:
Approved and Pending as of December 7, 20181
Notes
1. On November 20, 2018, CMS reapproved the Kentucky HEALTH waiver, including all of the provisions set aside in a previous decision issued by the DC federal district court in Stewart v. Azar, with minor technical changes. On June 29, 2018, the court set aside the Kentucky HEALTH waiver approval and sent the waiver back to HHS to reconsider the following provisions: the work requirement, monthly premiums up to 4% of income, coverage lockouts for failure to timely renew eligibility or timely report a change in circumstances, heightened cost-sharing for non-emergency ER use, and elimination of retroactive eligibility and non-emergency medical transportation. The separate “institution for mental disease” substance use disorder payment waiver was not set aside and was allowed to go into effect.
2. “Non-expansion” populations include traditional Medicaid populations (low-income parents, Transitional Medical Assistance, former foster care youth,
medically needy, etc.) but may also refer to narrow/limited populations that gained coverage through the demonstration waiver. For example, WI’s waiver covers childless adults ages 19 to 64 with income up to 100% FPL (without enhanced ACA matching funds). UT’s waiver expanded eligibility and provided a limited benefit package to certain nonelderly adults up to 100% FPL (the “PCN group”), and recently extended coverage to a limited group of childless adults who are homeless and have behavioral health needs up to 5% FPL. The pending waiver would apply differential benefit packages to parents up to 100% FPL and for childless adults up to 100% FPL (although benefits within each group would be the same).
3. IA: Premiums are waived for the 1st year of enrollment. In later years, premiums are waived if beneficiaries complete specified healthy behavior activities.
4. WI: Waiver covers childless adults ages 19 to 64 with income up to 100% FPL (without enhanced ACA matching funds).
5. NH: NH plans to end QHP premium assistance effective January 1, 2019 and transition beneficiaries to Medicaid MCOs.
6. Six other states (DE, MA, MD, RI, TN, and UT) have retroactive coverage waivers that pre-date the ACA and may have been associated with achieving the budgetary savings necessary to expand coverage before federal law authorized the use of Medicaid funds for childless adults. Some of these waivers apply to limited populations, and most have exceptions for seniors and people with disabilities.
AR: State waives retroactive eligibility except for the 30 days prior to the date of application for coverage.
UT: The approved retroactive waiver provision applies to only the PCN group. The pending waiver would permit retroactive coverage for those individuals eligible under the demonstration beginning no earlier than the demonstration implementation date.
7. Reasonable promptness waivers allow states to delay the start of coverage until after the 1st premium is paid or after the 60-day payment period expires.
8. In a CMS administrator letter to KS on May 7, 2018, CMS rejected KS’ proposal to impose a lifetime limit on Medicaid benefits for eligible beneficiaries.
AZ: Pending waiver request initially proposed adding a five-year maximum lifetime limit on Medicaid coverage for some beneficiaries, but an April 2018 letter from the AZ Medicaid director to the Governor announced the state’s decision to remove the time limit request from ongoing waiver discussions.
WI: CMS did not approve the state’s request to limit eligibility to no more than 48 months. Specifically, the state requested the authority to deem a childless adult ineligible for six months after 48 months of enrollment.
9. AZ: Proposes to redetermine eligibility every 6 months for all expansion enrollees and every 3 months for individuals who have a change in circumstance that results in non-compliance with waiver requirements
10. TX’s pending waiver refers to its “Healthy Women” family planning waiver.
11. Requests to limit expansion eligibility to 100% FPL with the enhanced match in AR and MA were not approved by CMS.
SOURCE: KFF analysis of approved and pending waiver applications posted on Medicaid.gov.
Waivers with Benefit, Copay, and Healthy Behavior Provisions:
Approved and Pending as of December 7, 20181
Notes
1. On November 20, 2018, CMS reapproved the Kentucky HEALTH waiver, including all of the provisions set aside in a previous decision issued by the DC federal district court in Stewart v. Azar, with minor technical changes. On June 29, 2018, the court set aside the Kentucky HEALTH waiver approval and sent the waiver back to HHS to reconsider the following provisions: the work requirement, monthly premiums up to 4% of income, coverage lockouts for failure to timely renew eligibility or timely report a change in circumstances, heightened cost-sharing for non-emergency ER use, and elimination of retroactive eligibility and non-emergency medical transportation. The separate “institution for mental disease” substance use disorder payment waiver was not set aside and was allowed to go into effect.
2. “Non-expansion” populations include traditional Medicaid populations (low-income parents, Transitional Medical Assistance for those moving from welfare
to work, former foster care youth, medically needy etc.) but may also refer to narrow/limited populations that gained coverage through the demonstration
waiver.
3. WI: waiver covers childless adults ages 19 to 64 with income up to 100% FPL (without enhanced ACA matching funds).
4. AR: The NEMT waiver in AR applies to ESI premium assistance enrollees only and is not included in this table.
KY: All NEMT services are waived for the expansion population. In addition to this blanket NEMT waiver for the expansion population, NEMT for methadone services only is waived for both expansion and non-expansion populations.
MA: NEMT waiver would not apply to substance use disorder treatment services.
5. Copays exceeding statutory limits are for non-emergent emergency room (ER) use in all pending and approved waivers noted except ME, which would charge copays above statutory limits for certain diagnosis codes. NM also would apply a copay above statutory limits non-preferred prescription drugs.
KY: Charge for non-emergent use of the ER assessed as a deduction from enrollee’s healthy behavior incentive account rather than as a direct fee/copayment.
6. KY: Charge for missed appointment assessed as a deduction from enrollee’s healthy behavior incentive account rather than as a direct fee/copayment.
7. OR has an EPSDT waiver as part of its demonstration testing an alternative delivery system model that allows the state to cover treatment services according to a priority list; the OR waiver is not included in this table.
UT: The approved provision applies to both the PCN and limited childless adult groups, while the pending waiver would apply to 19 and 20 year olds under the demonstration. UT’s approved waiver expanded eligibility and provided a limited benefit package to certain nonelderly adults up to 100% FPL (the “PCN group”), and recently extended coverage to a limited group of childless adults who are homeless and have behavioral health needs up to 5% FPL. The pending waiver would apply differential benefit packages to parents up to 100% FPL and for childless adults up to 100% FPL (although benefits within each group would be the same).
8. SC: South Carolina’s pending waiver proposes to add additional specifications and qualification requirements for family planning providers.
TX: pending waiver refers to its “Healthy Women” family planning waiver.
SOURCE: KFF analysis of approved and pending waiver applications posted on Medicaid.gov.
1. In July 2015, the CMS issued a state Medicaid director letter describing new service delivery opportunities for individuals with substance use disorder under Section 1115. In November 2017, the CMS issued a state Medicaid director letter revising the 2015 guidance.
2. In November 2018, CMS issued new guidance allowing states to obtain Section 1115 waivers of the federal IMD payment exclusion for services for individuals with serious mental health conditions.
VT: Vermont is required to submit a phase-down schedule for their IMD expenditures for individuals residing in an IMD who are there only to receive mental health (MH) treatment.
3. NY: New York’s pending waiver amendment also would move its existing financial eligibility expansion for children with behavioral health and HCBS needs who currently meet an institutional level of care from Section 1915 (c) to Section 1115 authority.
VA: The coverage expansion under the Virginia Governor’s Access Plan (GAP) and Addiction and Recovery Treatment Services (ARTS) Demonstration will be subsumed under Virginia’s Medicaid expansion.
4. MD: While no specific waiver authority is granted, Maryland’s approved waiver commits the state to developing and implementing a physical/behavioral health integration model for individuals with substance use disorders by January 1, 2019 as part of its IMD payment waiver.
MI: Michigan’s integration model currently exists under Section 1915 (b)/(c) authority that the state is seeking to convert to Section 1115.
SOURCE: KFF analysis of approved and pending waiver applications posted on Medicaid.gov.
Section 1115 Medicaid Waivers: Approved and Pending as of December 7, 2018
Source: Kaiser Family Foundation, State Health Facts, Approved Section 1115 Medicaid Waivers and Pending Section 1115 Medicaid Waivers, December 7, 2018.
Notes
GENERAL NOTES: “MLTSS” = Managed long-term services and supports, “BH” = Behavioral health. This table does NOT include family planning or CHIP-only waivers. Some states have multiple waivers, and many waivers are comprehensive and may fall into a few different areas. This table does NOT include/capture states mandating managed care through Section 1115 (since waiver authority is not generally required for these initiatives) and does not capture delivery system reform, behavioral health, or LTSS initiatives that do not require Section 1115 expenditure authority/federal funds. For additional details on what is included in each category, see category-specific notes and definitions.
1. Four states (CA, NY, RI & TX) have concurrent Section 1115A authority for financial alignment demonstrations that integrate Medicare and Medicaid benefits for dual eligible beneficiaries in a single health plan.
2. Kansas administers MLTSS through concurrent Section 1115/1915 (c) waivers.
3. On November 20, 2018, CMS reapproved the Kentucky HEALTH waiver, including all of the provisions set aside in a previous decision issued by the DC federal district court in Stewart v. Azar, with minor technical changes. On June 29, 2018, the court set aside the Kentucky HEALTH waiver approval and sent the waiver back to HHS to reconsider the following provisions: the work requirement, monthly premiums up to 4% of income, coverage lockouts for failure to timely renew eligibility or timely report a change in circumstances, heightened cost-sharing for non-emergency ER use, and elimination of retroactive eligibility and non-emergency medical transportation. The separate “institution for mental disease” substance use disorder payment waiver was not set aside and was allowed to go into effect.
4. Pennsylvania was granted authority to use Medicaid funds to provide services to adults residing in institutions for mental diseases (IMDs) for short-term acute substance use disorder (SUD) treatment. The state received this authority through an amendment to the state’s only active Section 1115 waiver that specifically targets former foster care youth (FFY) who aged out of foster care while residing in a different state (FFY were previously covered under state plan and due to a change in CMS policy, they have been shifted to coverage under waiver authority). (This waiver tracker does not include/track FFY coverage waivers.) The IMD authority applies to all Medicaid-eligible individuals with SUD (not just former foster care youth).
SOURCE: KFF analysis of approved and pending waiver applications posted on Medicaid.gov.
Notes
GENERAL NOTES: “MLTSS” = Managed long-term services and supports, “BH” = Behavioral health. This table does NOT include family planning waivers (with the exception of Texas’ Healthy Women waiver) or CHIP-only waivers. Some states have multiple waivers, and many waivers are comprehensive and may fall into a few different areas. Pending waivers include new applications, amendments to existing waivers, and renewal/extension requests. State waiver renewals that do not propose changes and amendments that are technical in nature are excluded. Pending waiver applications are not included in this table until they are officially accepted by CMS and posted on Medicaid.gov. This table does NOT capture states mandating managed care through Section 1115 (since waiver authority is not generally required for these initiatives) and does not capture delivery system reform, behavioral health, or LTSS initiatives that do not require Section 1115 expenditure authority/federal funds. For additional details on what is included in each category, see category-specific notes and definitions.
1. Arizona’s pending waiver request initially proposed adding a five-year maximum lifetime limit on Medicaid coverage for some beneficiaries, but an April 2018 letter from the AZ Medicaid director to the Governor announced the state’s decision to remove the time limit request from ongoing waiver discussions.
2. In a CMS administrator letter to Kansas on May 7, 2018, CMS rejected Kansas’ proposal to impose a lifetime limit on Medicaid benefits for eligible beneficiaries.
SOURCE: KFF analysis of approved and pending waiver applications posted on Medicaid.gov.
