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 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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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…
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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…