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  • State Policy Choices About Medicaid Home and Community-Based Services Amid the Pandemic

    Issue Brief

    This issue brief presents findings on key state policy choices about Medicaid HCBS in FY 2020. This is the latest data available, and the first since the onset of the COVID-19 pandemic. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC. A related brief presents the latest state-level data about the number of people receiving HCBS and HCBS spending

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

    Issue Brief

    Section 1115 Medicaid waivers can allow states to test new approaches in Medicaid that differ from what is required by federal law. This page tracks approved and pending waiver provisions (including expansions and restrictions) related to eligibility, benefits, and social determinants of health and other delivery system reforms.

  • Section 1115 Waiver Watch: Continuous Eligibility Waivers

    Policy Watch

    The pandemic continuous enrollment provision and other research show that continuous eligibility reduces Medicaid disenrollment and “churn” rates and helps to ensure stable coverage. As many Medicaid enrollees are currently experiencing disruptions in coverage as a result of the Medicaid unwinding, a number of states are pursuing strategies to help promote continuity of coverage, including through unwinding waivers and Section 1115 demonstration waivers. This Waiver Watch summarizes approved and pending Section 1115 waivers with continuous eligibility provisions for children and adults in Medicaid.

  • State Options to Expand Medicaid HCBS: Examples & Evaluations of Section 1115 Waivers

    Issue Brief

    States are currently developing plans to access an increased federal matching rate (“FMAP”) for Medicaid HCBS spending established in the American Rescue Plan Act (ARPA) of 2021. In the future, states may also be able to access increased HCBS funds proposed in the Biden Administration’s American Jobs Plan and the Better Care Better Jobs Act recently introduced in Congress. This brief highlights examples of Medicaid HCBS policy changes authorized through Section 1115 demonstration waivers in seven states (Arizona, Delaware, New Jersey, New York, Rhode Island, Vermont, and Washington). Where available, we discuss waiver evaluation findings and reports that assess the impact of these policy changes.

  • The Landscape of Medicaid Demonstration Waivers Ahead of the 2020 Election

    Issue Brief

    As the Trump administration reaches the end of its first term, this issue brief considers the landscape of approved and pending Section 1115 Medicaid demonstration waivers under this administration and how the November 2020 presidential election may impact this landscape.

  • Section 1115 Waiver Watch: Medicaid Pre-Release Services for People Who Are Incarcerated

    Issue Brief

    In April 2023, the Centers for Medicare and Medicaid Services (CMS) 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. As of August 19, 2024, CMS has approved Section 1115 reentry waiver requests from 11 states, while 13 additional reentry waivers remain pending.

  • What is Medicaid Estate Recovery?

    Issue Brief

    Under estate recovery, state Medicaid programs are required to recover the costs of long-term care and related hospital and prescription drug services for enrollees ages 55 and older. KFF examines the wide variation in estate recovery practices across states as well as the criticisms of this policy, which have led to federal proposals to modify or reduce it.

  • Implementing Work Requirements on a National Scale: What We Know from State Waiver Experience

    Policy Watch

    On May 18, the House Budget Committee advanced a budget reconciliation bill that includes significant changes to the Medicaid program. As anticipated, Medicaid work requirement provisions are included and preliminary estimates released by the Congressional Budget Office (CBO) show that this provision would reduce federal spending by $280 billion over ten years, nearly half of all estimated Medicaid savings in the bill. The provisions raise many operational and implementation questions, particularly considering the experience of Arkansas and Georgia with implementing work requirements through waivers.

  • Section 1115 Waiver Watch: A Look at the Use of Contingency Management to Address Stimulant Use Disorder

    Policy Watch

    Contingency management is an evidence-based psychosocial intervention that uses motivational incentives, such as vouchers or gift cards, to encourage recovery behaviors like stimulant abstinence and treatment session (e.g., cognitive behavioral therapy, group therapy) attendance. The Biden administration has approved five state contingency management waivers (California, Delaware, Hawaii, Montana, and Washington); two additional state contingency management requests are currently pending federal review.