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Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State

Published: Aug 1, 2025
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Section 1115 Medicaid demonstration waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute, if [in the HHS Secretary’s view] the approach is likely to “promote the objectives of the Medicaid program.” They can provide states additional flexibility in how they operate their programs, beyond the considerable flexibility that is available under current law. Waivers generally reflect priorities identified by states as well as changing priorities from one presidential administration to another. Nearly all states have at least one active Section 1115 waiver and some states have multiple 1115 waivers. See the “Key Themes Maps” tab for a discussion of recent waiver trends.

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. For more information on inclusion criteria and on each provision, as well as a list of acronyms, see the Definitions tab.

Medicaid Watch

Policy research, polling and news about the Medicaid financing debate.

Detailed Topic Tables

Aggregate State Tables

Landscape of Approved and Pending Section 1115 Waivers

 

Waivers with Eligibility Changes

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Section 1115 Eligibility Changes - Expanded Eligibility Groups

Waivers with Benefit Changes

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Section 1115 Benefit Changes - Expansions

Waivers with SDOH & Other DSR Changes

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Section 1115 SDOH Provisions

All Approved Waivers by Topic

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Approved Section 1115 Medicaid Waivers

All Pending Waivers by Topic

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Pending Section 1115 Medicaid Waivers

Work Requirements

The 2025 budget reconciliation legislation, signed into law on July 4, requires states to condition Medicaid eligibility for adults in the ACA Medicaid expansion group on meeting work requirements starting January 1, 2027, with the option for states to implement requirements sooner.

Prior to the passage of the federal reconciliation legislation and since January 2025, some states have shown renewed interest in pursuing work requirement policies through 1115 waivers. The first Trump administration encouraged and approved 1115 demonstration waivers that conditioned Medicaid coverage on meeting work requirements which were subsequently rescinded by the Biden administration or withdrawn by states. Currently, Georgia is the only state with a Medicaid work requirement waiver in place following litigation over the Biden administration’s attempt to stop it. Pending work requirement waivers may need to be altered to conform with the budget reconciliation legislation framework.

The map below identifies approved (Georgia) and pending work requirement waivers (submitted to CMS since January 2025) as well as states with proposals that have been released at the state-level for “public comment.” The table below the map provides more detailed state waiver information and a summary of recent state legislative activity involving work requirements.

For more information on Medicaid work requirements, see additional KFF resources:

  • An overview of the work requirement provisions in the 2025 budget reconciliation legislation, including key operational & implementation questions (2025)
  • Analyses of the work status and characteristics of Medicaid enrollees (2025)
  • A short brief highlighting five key facts about Medicaid work requirements, including what the research shows about the impact of work requirements (2025)
  • A detailed history of Medicaid work requirements (2022)
Section 1115 Approved and Pending Work Requirement Waivers

The table below provides more detailed state waiver information for waivers that are approved and pending at the federal level, as well as activity at the state-level once a waiver proposal has been released for state-level “public comment.” This table also lists states with legislative activity involving work requirements, once a bill has passed out of committee (typically the first step of the legislative process). Some states require state legislative action before Section 1115 waiver requests can be submitted by the state Medicaid agency to CMS for federal approval and others do not.

Key States with Work Requirement Waiver Activity

Key Themes Maps

Section 1115 waivers generally reflect priorities identified by states as well as changing priorities from one presidential administration to another.  Key Biden administration 1115 initiatives included waivers addressing enrollee health-related social needs (HRSN), pre-release coverage for individuals who are incarcerated, and multi-year continuous eligibility for children.

In March 2025, the Trump administration rescinded HRSN guidance issued by the Biden administration. CMS indicates this does not nullify existing HRSN 1115 approvals but going forward they will consider HRSN / SDOH requests on a case-by-case basis. In July 2025, the Trump administration released guidance indicating it will not approve (new) or extend (existing) continuous eligibility waivers for children or adults. CMS also announced in July it would be phasing out initiatives to strengthen the Medicaid workforce for primary care, behavioral health, dental, and home and community based services (not depicted in maps below).

This page tracks pending and approved waivers in key areas of recent state activity and will track Trump administration action in these areas going forward. Hover over individual states to display waiver expiration dates.

Social Determinants of Health

Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. SDOH include but are not limited to housing, food, education, employment, healthy behaviors, transportation, and personal safety. In 2022, CMS (under the Biden administration) announced a demonstration waiver opportunity to expand the tools available to states to address enrollee “health-related social needs” (or “HRSN”) including housing instability, homelessness, and nutrition insecurity, building on CMS’s 2021 guidance. In 2023, CMS issued a detailed Medicaid and CHIP HRSN Framework accompanied by an Informational Bulletin, which were updated in 2024.

In March 2025, the Trump administration rescinded the Biden administration HRSN guidance. CMS indicates this does not nullify existing HRSN approvals but going forward they will consider HRSN / SDOH requests on a case-by-case basis.

The “HRSN Waivers” map below identifies states with approval under the Biden administration HRSN framework. The “All SDOH Waivers” map identifies SDOH-related 1115 waivers more broadly, including those that pre-date or were approved outside of the HRSN framework. For more detailed waiver information, refer to KFF’s Medicaid Waiver Tracker (“SDOH” table) and HRSN waiver watch  (March 2024).

Section 1115 Waivers: Social Determinants of Health (SDOH)

Medicaid Pre-release Coverage for Individuals Who Are Incarcerated

In April 2023, the Biden administration released guidance encouraging states to apply for a new Section 1115 demonstration opportunity to test transition-related strategies to support community reentry for people who are incarcerated. This demonstration allows states a partial waiver of the inmate exclusion policy, which prohibits Medicaid from paying for services provided during incarceration (except for inpatient services). Reentry services aim to improve care transitions and increase continuity of health coverage, reduce disruptions in care, improve health outcomes, and reduce recidivism rates. The Biden administration approved 19 state waivers to facilitate reentry for individuals who are incarcerated. The map below identifies states with approved and pending waivers to provide pre-release services to Medicaid-eligible individuals who are incarcerated.  Medicaid pre-release waivers have been pursued by both Republican and Democratic governors. For more information, refer to KFF’s Medicaid Waiver Tracker (“Eligibility Changes” table) and related pre-release waiver watch (August 2024).

Section 1115 Waivers: Medicaid Pre-release Coverage for Individuals Who Are Incarcerated

Multi-year Continuous Eligibility for Children

The Consolidated Appropriations Act, 2023 required all states to implement 12-month continuous eligibility for children beginning on January 1, 2024. The Biden administration approved 9 waivers that allow states to provide multi-year continuous eligibility for children (e.g., from birth to age six). Continuous eligibility has been shown to reduce Medicaid disenrollment and “churn” rates (rates of individuals temporarily losing Medicaid coverage and then re-enrolling within a short period of time).

In July 2025, the Trump administration released guidance indicating it will not approve (new) or extend (existing) continuous eligibility waivers for children or adults. The map below displays states with waiver approval to provide multi-year continuous eligibility for children.  For more information, refer to KFF’s Medicaid Waiver Tracker (“Eligibility Changes” table) and related continuous eligibility waiver watch (February 2024).

Section 1115 Waivers: Multi-year Continuous Eligibility for Children

Definitions

Section 1115 Waiver Tracker: Key Definitions and Notes

Related Resources

Recent Developments

General/Overview Resource

Eligibility and Enrollment Expansions

Eligibility and Enrollment Restrictions

Work Requirements:

Other:

Benefit Expansions

Benefit Restrictions, Copays, and Healthy Behaviors

Social Determinants of Health

Delivery System Reform

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Medicaid Medicaid Work Requirements Waivers