State Waivers

States may seek a waiver as vehicle for demonstrating or implementing new or different ways to administer (deliver and pay for) their Medicaid, CHIP and Health Insurance Marketplace programs.  Summaries of the most common types of waivers, the various authorities each waiver includes, and resources for information on each type of waiver can be found at the following NACHC fact sheet:  Summary of State Waiver Options.

While there are many types of waivers, those that are most often relevant for health centers and their patients are Section 1115 and Section 1332 waivers. A list of resources related to these waiver types appears below and will be updated periodically with new information.  NACHC members visiting this webpage are also strongly encouraged to search NACHC’s vast catalogue of resources in MyNACHC Learning Center.

Section 1115 “Demonstration Project” Waivers

An 1115 waiver is the broadest type of waiver available under Medicaid. Officially, these waivers are to be used by states to create demonstration projects intended to improve Medicaid and/or CHIP programs, and they must include a formal evaluation of impact. (See Summary of State Waiver Options)

Read more about Section 1115 waivers:
Read the statutes and/or regulations:
Search for a state Medicaid waiver:  

Section 1332 “State Innovation” Waivers

A 1332 waiver, otherwise known as a “State Innovation Waiver,” allows states to waive Affordable Care Act (ACA) provisions related to the Health Insurance Marketplaces and the individual and employer mandates. However, these waivers cannot be used to waive the basic protections of the ACA (e.g., prohibition on lifetime caps, nondiscrimination provisions, and guaranteed access to fair prices for all enrollees).  Section 1332 waivers also cannot be used to waive statutory provisions in the Medicaid, Medicare, CHIP, or the Public Health Service Acts; however, they can be coordinated, and submitted in conjunction with waiver requests involving these programs. (See Summary of State Waiver Options)

Read more about Section 1332 waivers:
Read the statutes and regulations:

Additional Waiver Resources

For more information on other vehicles states can use to design their Medicaid, CHIP and marketplace programs, see the following resources: