Waivers
State Medicaid programs must comply with federal requirements, but states seeking additional flexibility can apply for formal waivers of some of these requirements from the Secretary of Health and Human Services (HHS). For example, states can use waivers to offer an alternative benefit plan to a subset of Medicaid beneficiaries, to restrict enrollees to a specific network of providers, or to extend coverage to groups beyond those defined in Medicaid law. The extensive use of waivers (every state now has at least one Medicaid waiver agreement in place) has contributed to wide variations in program design, covered services, and eligible populations among states and even within states.
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Featured Publications
Recent Developments in Section 1115 Demonstration Waivers: Implications for Future Policy
December 8, 2022
The Centers for Medicare & Medicaid Services (CMS) has recently approved several large-scale Section 1115 demonstration waivers that allow states to test the efficacy of new approaches to delivering Medicaid services and improving population health. These include changes to eligibility rules, benefit coverage, and measures to address the social determinants of health and health-related social […]
Section 1115 Demonstration Budget Neutrality
December 21, 2021
Medicaid spending under Section 1115 demonstrations is required to be budget neutral, meaning that federal spending under the demonstration cannot exceed projected costs in the absence of the demonstration (referred to as the without-waiver baseline). If state spending under its demonstration is below the without-waiver baseline, the difference is considered savings. The state can use […]
Medicaid Work and Community Engagement Requirements
June 26, 2020
A number of states have requested Section 1115 waiver authority to impose work and community engagement requirements as a condition of Medicaid eligibility. Between 2017 and 2020, the Centers for Medicare & Medicaid Services (CMS) granted waivers to a number of states to adopt work and community engagement requirements and issued subregulatory guidance indicating the […]