Section 1115 of the Social Security Act establishes authority for the Secretary of Health and Human Services (HHS) to waive certain provisions of the Medicaid and CHIP statutes for a state to establish an “experimental, pilot or demonstration” project that promotes the objectives of the program. Such demonstrations are intended to test and learn about new approaches to program design and administration. States have obtained Section 1115 waivers that make broad changes in Medicaid eligibility, benefits, cost sharing, and delivery and payment of care.
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The Future of ACA’s Medicaid Expansion: What do Changes in HR1 Mean?
The federal budget reconciliation bill signed by President Trump, H.R. 1, made multiple cuts to the Medicaid program that were designed to deter states from expanding Medicaid. Ten states, mostly in the South, have not expanded Medicaid to low-income adults. Despite many attempts by proponents of large Medicaid cuts to lower the expansion match of…
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Tracking State Readiness to Implement HR 1
This tracker will report on eight state-reported Medicaid and CHIP performance indicators. The analysis of state data is displayed in national maps for the most recent quarter broken into four quartiles with the top quartile reflecting the highest performing states. To smooth out monthly anomalies in state workload and allow for tracking these metrics over time,…
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Webinar: Budget Reconciliation (HR1) Medicaid and Marketplace Provisions
In Partnership with Monday, July 28, 2025 the Georgetown University McCourt School of Public Policy Center for Children and Families (CCF) and Center on Health Insurance Reforms (CHIR) held a joint webinar about the Medicaid and Marketplace provisions of the new budget reconciliation law (HR1). Experts at CCF and CHIR explained the provisions of the…
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The Tennessee “Shared Savings” Waiver: Not a Medicaid Block Grant
As our colleague Edwin Park has explained, there is keen interest on the part of some Congressional Republican leaders in capping federal Medicaid payments to states, ideally by converting Medicaid from a health insurance program into a block grant. Currently, the federal government matches state spending for the costs of health and long-term care services…
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Approved and Pending Section 1115 Demonstrations to Provide Health-Related Social Need Services to Pregnant and Postpartum Individuals and Children
Last Updated August 28, 2024 States are increasingly seeking to leverage Medicaid to provide services and supports to address health-related social needs (HRSN) services and supports, particularly through section 1115 demonstration projects. Pregnant and postpartum individuals and children are key populations states are targeting in their efforts to cover HRSN services. Addressing unmet HRSN among…