Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State
Published: Sep 26, 2023
This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute. Key themes in current approved and pending waivers include targeted eligibility expansions, benefit expansions (particularly in the area of behavioral health, such as coverage of services provided in IMDs), and provisions related to social determinants of health. States may obtain “comprehensive” Section 1115 waivers that make broad changes in Medicaid eligibility, benefits, provider payments, and other rules across their programs; other waivers may be more narrow and address specific populations or benefits.
Section 1115 waivers generally reflect priorities identified by the states and the federal Centers for Medicare and Medicaid Services (CMS), as well as changing priorities from one presidential administration to another. In particular:
- Beginning in the 1990s, there was an increase in waiver activity, and waivers became broader in scope. Under different administrations in the past, waivers have been used to expand coverage, modify delivery systems, and restructure financing and other program elements.
- The Trump Administration’s Section 1115 waiver policy emphasized work requirements and other eligibility restrictions, payment for institutional behavioral health services, and capped financing.
- The Biden Administration has signaled a shift in policy to emphasize waivers that expand, rather than restrict, Medicaid coverage and access to care (though still within the limits of budget neutrality). The Biden Administration has withdrawn work requirement approvals (these are reflected on the Work Requirements Tab) and started to phase out premium requirements, and has instead encouraged states to propose innovative Section 1115 waivers that expand coverage, reduce health disparities, and/or advance whole-person care (including addressing health-related social needs).
This page tracks approved and pending Section 1115 waiver provisions (including expansions and restrictions) related to eligibility, benefits, and social determinants of health and other delivery system reforms, once such waivers are posted to the State Waivers List on Medicaid.gov. This information is contained in the following tables:
Detailed Topic Tables
Aggregate State Tables
For more information on inclusion criteria and on each provision, as well as a list of acronyms, see the Definitions tab.