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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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…
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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…
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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…
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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…
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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…