Key Section 1115 Medicaid Waivers
Section 1115 of the Social Security Act allows the Secretary of the Department of Health and Human Services to approve state Medicaid
demonstration projects that promote the objectives of the program but may not otherwise be allowed under the Medicaid statute. CHA provides an overview of the current approved Section 1115 demonstration waiver landscape and identifies whether these waivers are consistent with CHA’s Section 1115 waiver principles for children’s coverage
, which were adopted to assess how waivers impact children.
CHA highlights four categories of waivers: delivery system reform, multi-component, adult expansion, and targeted population and/or services waivers. The map below shows the key themes of existing waivers in each state and includes links to brief waiver summaries. The map does not highlight nor include summaries of pending waivers or amendments and approved demonstrations with a focus on family planning services, HIV/AIDs, or services for senior citizens.
State waiver summaries
State waiver categories and elements by state
Delivery system/payment reform Targeted population/services Adult Medicaid expansion
Multi-component No approved waiver
*Arkansas, Michigan and Minnesota have a second targeted population/services waiver. New Hampshire has a second adult Medicaid expansion waiver. Ohio's "Healthy Ohio Program" was not approved by CMS.
The above map requires scrolling away from the continental U.S. to locate Alaska and Hawaii. Hawaii has an approved multi-component waiver.
Waiver category and theme descriptions
The following are four broad categories that CHA has identified as common topics across approved Section 1115 demonstrations. Each waiver has been identified by one of these categories:
- Adult Medicaid Expansion - Waiver authority is used to implement the adult Medicaid expansion under the Affordable Care Act.
- Delivery system/ payment reform - Waivers with a delivery system reform incentive payment (DSRIP) or value-based delivery system and/or payment reform initiative.
- Multi-component - Long-standing, comprehensive waivers and, for multiple states, reflect the creation and management of the state’s entire Medicaid program.
- Targeted population/services - Waivers that expand Medicaid coverage to particular populations or expand coverage of particular services.
The following are key themes found in approved waivers. These themes are not necessarily specific to kids. We have highlighted changes made to these themes through Section 1115 waiver authority:
- Behavioral health - Mental health and/or substance use disorder services or integration of physical and behavioral health services.
- Delivery System Reform Incentive Payment Program (DSRIP) - Programs that encourage providers to engage delivery system reform efforts and tie payments to health outcome improvements for Medicaid beneficiaries.
- Eligibility/enrollment - Eligibility or enrollment provisions, including but not limited to, retroactive eligibility, presumptive eligibility, enrollment caps, or lock-out periods.
- EPSDT - Provision affecting EPSDT requirement for children up to age 21.
- Home and Community-based Services (HCBS) - Addresses HCBS for individuals with disabilities or chronic conditions.
- HSA-lookalike - Program operated similar to a health savings account.
- Innovative pediatric initiative - Includes child only pilot program(s) or other initiative(s).
- Long-term Services and Supports (LTSS) - Delivers or impacts LTSS or managed LTSS.
- Managed care - Waiver authority used to implement managed care delivery system.
- Premium assistance - Impacts Medicaid provisions that allow state programs to pay private insurance premiums for beneficiaries.
- Premiums/cost-sharing - Modifies premium and/or cost-sharing requirements or limits authorized in the federal Medicaid statute.
- Supplemental payments - Payments to hospitals that are not tied to a particular service (e.g., payments from a provider tax, low-income/uncompensated care pool).
- Value-based model - Delivery system and/or payment reform initiative outside of DSRIP that may include components such as care coordination, provider performance incentive payments, quality improvement metrics and/or addresses social determinants of health.
- Wellness incentive - Incentive payments or reductions used to offset cost-sharing requirements for beneficiaries who engage in recommended healthy behaviors.