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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.

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Section 1332 State Innovation Waivers: Current Status and Potential Changes

Section 1332 of the Affordable Care Act (ACA) authorizes states to waive key requirements under the law in order to experiment with different health coverage models. As Republicans in Congress debate repeal and replacement of the ACA, renewed attention is being paid to these waivers as a mechanism for giving states flexibility to restructure their health care markets. This brief describes current 1332 waiver activity, including proposals in the Senate’s Better Care Reconciliation Act (BCRA), and raises questions regarding the future of these waivers, particularly in the context of proposed changes under discussion.

How ACA Repeal and Replace Proposals Could Affect Coverage and Premiums for Older Adults and Have Spillover Effects for Medicare

This brief explains the key AHCA provisions that would reshape the private market to more closely resemble the pre-Affordable Care Act period, and the effects of these changes on adults ages 50-64. The brief also discusses how changes to Medicaid could affect older, low-income adults, and how an increase in the number of uninsured older adults could have implications for the Medicare program in the future.

Proposed Medicaid Section 1115 Waivers in Maine and Wisconsin

While the future of legislation to repeal and replace the Affordable Care Act (ACA) and make fundamental changes to the structure and funding of the Medicaid program is uncertain, states and the Administration may achieve major changes to Medicaid through the use of Section 1115 Medicaid waivers. Wisconsin submitted a waiver amendment request to CMS in June 2017 and Maine submitted a waiver application to CMS in August 2017. 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.

Kaiser Media Fellowships 2017 Indiana Site Visits

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…

State Medicaid Expansion Approaches

Current Status of State Medicaid Expansion Decisions States Did the state expand Medicaid?* How did the state expand Medicaid? In non-expansion states: Has there been legislative or administrative activity to pursue expansion in 2017?* How many uninsured adults could gain Medicaid if the state expanded?* United…

Don’t Expect Medicaid Work Requirements to Make a Big Difference

Under the Trump Administration, some Republican governors may look to move their Medicaid programs in a more conservative direction. In his latest column for Axios, Drew Altman discusses the arguments about Medicaid “work requirements” and why few people are likely to be affected by them in practice.

Brief Examines State Requests to Impose Work Requirements in Medicaid

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…

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