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.
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.
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.
Read more about Section 1115 waivers:
- NACHC Medicaid Waiver Principles
- CMS Issues Guidance on Community Engagement and Work Requirement Proposals for Medicaid, NACHC Blog (January 2018)
- The New Medicaid Landscape: How the Administration May Increase Flexibility for States, NACHC Blog (March 2017)
- Update on Medicaid Expansion via 1115 Waivers, NACHC Publication (June 2016)
- Medicaid Section 1115 Waivers: Pathways for Delivery Transformation, NACHC Publication (August 2014)
- Section 1115 Waiver Transparency Process, NACHC Publication (December 2013)
- Model Legislation: Requiring legislative approval of state 1115 waiver submissions, NACHC Publication (November 2015)
- Section 1115 Medicaid Demonstration Waivers: A Look at the Current Landscape of Approved and Pending Waivers KFF Issue Brief (Updated Frequently)
- Background to Medicaid and Section 1115 of the Social Security Act, NHeLP Issue Brief (April 2017)
- Sec. 1115 Waiver Requests: Transparency & Opportunity for Public Comment, NHeLP Issue Brief (April 2017)
- Current FQHC-Specific Language in Medicaid 1115 Waivers and SPAs – State Policy Report #24 NACHC Publication (June 2009)
Read the statutes and/or regulations:
Search for a state Medicaid waiver:
- 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.
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. 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.
Read more about Section 1332 waivers:
- 1332 Waivers and Health Centers, NACHC Publication (June 2016)
- CMS’ Center for Consumer Information & Insurance Oversight webpage
Read the statutes and regulations:
- Federal Statute – 42 U.S.C. Section 18052 (Section 1332 of the ACA)
- Federal Regulations – 31 C.F.R. Part 33 and 45 C.F.R. Part 155 (77 Fed. Reg. 11700)
Additional Waiver Resources
For more information on other vehicles states can use to design their Medicaid, CHIP and marketplace programs, see the following resources:
- MACPAC Medicaid 101 Waivers webpage
- Medicaid and CHIP Waivers (state waivers, comments, and resources), Georgetown Univ. Health Policy Institute’s Center for Children and Families (Updated Periodically)
- Current Flexibility in Medicaid: An Overview of Federal Standards and State Options, KFF Issue Brief (January 2017)
- CMS’ “At-a-Glance’ Guide to Federal Medicaid Authorities Useful in Restructuring Medicaid Health Care Delivery or Payment (April 2012)
- State Waiver Resource and Tracking Center (1115 and 1332 state waivers), Families USA Interactive Hub (Updated Periodically)
- More States Looking to Section 1332 Waivers, State Health Reform Assistance Network (November 2017, Updated Periodically)
- State Plan Amendments and Waivers: How States Can Change Their Medicaid Programs Families USA Issue Brief (June 2012)