Waivers
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.
Webinar: Using Section 1115 Demonstrations to Support Health-Related Social Needs for Prenatal to 3 Population
Over the past few years, states have been increasingly seeking to use Medicaid section 1115 demonstrations to cover health-related social needs (HRSN) services and supports. While many states are including pregnant and postpartum individuals and their children as eligible populations to receive these benefits, not all individuals within the pregnancy and postpartum eligibility group will […]
District Court Strikes Down Approvals of Harmful Waivers in Indiana (and Shows the Supreme Court is Wrong About Many Things)
After a week full of partisan and poorly-reasoned Supreme Court decisions, it was a relief to see that at least one federal court continues to do its job faithfully. The U.S. District Court for the District of Columbia issued yet another stellar section 1115 demonstration decision, in a case called Rose v. Becerra, vacating the […]
Delaware and Tennessee Become First States to Cover Diapers for Young Children in Medicaid through Section 1115 Demonstrations
Last week, CMS announced the approval of section 1115 demonstration project requests from Delaware and Tennessee to provide diapers to young children covered by Medicaid. These approvals mark the first time a state has been authorized to cover diapers for infants in Medicaid regardless of medical necessity due to incontinence issues. Under federal statute, section […]
Update: Georgia Now Suing CMS For Denying an Extension Request That Hasn’t Really Even Been Filed
As we have recently covered, and as we explained before it launched, Georgia’s “Pathways to Coverage” demonstration is riddled with defects. Pathways is the state’s alternative to a standard Medicaid expansion—an expansion with work requirements that has resulted in Georgia enrolling (as best we can tell) less than one percent of those eligible (yes, that’s […]
CMS Unsurprisingly Concludes Georgia Demonstration Extension Request Is… An Extension Request
On December 22, CMS sent Georgia a letter confirming that the state’s section 1115 demonstration extension request was being reviewed as an extension request. This straightforward conclusion, which the state was trying to avoid, has some important consequences for the state’s on-going Medicaid expansion debacle. But let’s start with the background. In February 2023, Georgia […]
Georgia Pathways Implementation: The Glass is 99.6% Empty
On October 5, 2023, CMS certified as complete Georgia’s implementation plan (the implementation plan itself starts on page 50) for phase one of its “Pathways to Coverage” section 1115 demonstration that the state had already started implementing more than 3 months earlier, on July 1, 2023. Yes, you read that right. And no, it doesn’t […]