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.
Medicaid Wars: The Unwinding (and Litigation) Continues (Episode IV)
It’s been seven months and change since the Biden Administration took office. What it found waiting for it on January 20 was not just a crisis of democracy and a global pandemic and a surge of unaccompanied children at the border, but also a large pile of policy intended to undercut the Administration’s ability to […]
Federal Government Accepting Public Comments on Tennessee Medicaid Block Grant Waiver Restricting Access to Prescription Drugs
The Centers for Medicare and Medicaid Services (CMS) have reopened a 30-day public comment period for Tennessee’s controversial section 1115 waiver, which the Trump Administration approved in January 2021. While the waiver’s radical centerpiece converting the state’s federal Medicaid funding into a block grant has rightfully received the most attention, the waiver would also allow […]
Biden Administration Takes Further Action to End Barriers to Medicaid Coverage
Nearly six months ago, the Biden Administration initiated efforts to withdraw work reporting requirements in the eleven states with approved section 1115 Medicaid waivers. Now, the resolution many have been waiting for is almost entirely complete. On August 10, Ohio, South Carolina, and Utah all received letters from CMS formally withdrawing their work requirement waivers. […]
More States Moving to Extend Medicaid Postpartum Coverage Option Under ARP, Why Are Georgia and Missouri Limiting Its Reach?
Extending postpartum coverage continues to be a hot topic in state legislatures, in Congress, and in the Biden Administration. As my colleagues shared in a blog last week, CMS recently approved Section 1115 demonstration waivers in Georgia and Missouri that extend postpartum benefits to at least some pregnant people. While a step forward, the approvals […]
Georgia and Missouri Postpartum Medicaid Waiver Approvals Promote Limited Coverage
As Say Ahh readers know, there have been bursts of Section 1115 demonstration activity since the start of the year. April was no different, bringing another flurry of actions from CMS. This time, however, there were some new demonstration approvals that promote coverage, albeit in a more limited way than we would have liked to […]
Medicaid Wars: Litigation Risk (Episode III)
It turns out that unwinding illegal Medicaid policies is complicated. There’s this thing called “litigation risk”. Executive Branch agencies have to make reasoned decisions and stay within their statutory guardrails; if they don’t the federal courts may rein them in. As it happens, litigation risk goes both ways. The Unwinding began with the issuance of […]