State Medicaid Waivers

States are increasingly looking for ways to achieve the Triple Aim – lowering the cost of their Medicaid programs while improving access to care and quality of care for their beneficiaries. Some states are using waivers made available under Section 1115 of the Social Security Act (SSA) to help them test new ideas in their Medicaid program. Section 1115 of the SSA gives the Secretary of the Department of Health and Human Services the authority to waive certain requirements of federal Medicaid law so long as the Secretary finds that the state’s waiver program is likely to promote the objectives of the Medicaid program. Under an 1115 waiver, states may propose to waive many of the key provisions of the Medicaid statute, including but not limited to: which individuals are covered; which benefits those individuals will receive; if and how much beneficiaries will be charged for premiums and copayments; and how providers will be paid. 1115 waivers are considered demonstration projects – they are expected to be budget neutral, not adding expenses to the federal or state governments’ budgets, and require a formal evaluation of their impact.

Quick References

Learn more about state waivers and how NACHC monitors and evaluates various waiver proposals below.

NACHC’s Medicaid Waiver Principles
NACHC Update: Recent State Waiver Activity
NACHC Fact Sheet: Summary of State Waiver Options
Centers for Medicare and Medicaid Services (CMS) state waivers list – State-by-state information on current and pending waivers under Sections 1115, 1915 (b), and 1915(c) of the Social Security Act.

Helpful Resources

NACHC Issue Brief: Section 1115 Waiver Transparency Process
NACHC State Policy Report: Medicaid Section 1115 Waivers-Pathways for Delivery Transformation
NACHC Template: Model State Legislation Requiring Legislative Approval of Submission of Section 1115 Waiver Proposal
MACPAC Medicaid 101: Waivers 

Important Links

Federal Statute – Section 1115 (Social Security Act)
Federal Regulations – 1115 Waiver Regulations
National Health Law Program’s Background to Medicaid and Section 1115 of the Social Security Act
Medicaid and CHIP Waivers – Information on state waivers, comments, and resources from Georgetown University’s Health Policy Institute’s Center for Children and Families (Updated Periodically)