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.
Texas Medicaid Section 1115 Waiver Drama: A Trilogy
The world of Section 1115 Medicaid waivers can be mysterious and weedy, arcane and annoying, boring and, at times, dramatic. And in recent years, the use of Section 1115 authority by the Trump Administration stretched all previously known boundaries and wound up in court on multiple occasions – most famously in the Arkansas work requirements […]
Georgia’s 1332 Waiver Proposal Puts Children and Families at Risk of Losing Coverage
In 2020, Georgia submitted a waiver under Section 1332 of the Affordable Care Act (ACA) to allow the state to exit HealthCare.gov; the Trump Administration approved the request in November of last year. Under this proposal, the 500,000 Georgians who use the federal marketplace every year to enroll in private health plans and Medicaid would […]
Oregon’s 1115 Medicaid Waiver Request is a Mixed Bag
State seeks to become the first to provide continuous coverage to all children enrolled in Medicaid until age six while continuing to restrict children’s access to health care by continuing to deny them the EPSDT benefit package provided to children in all other states. After months of engaging stakeholders, Oregon has posted its draft […]
Retroactive Coverage Should Not Be Waived in Florida or Anywhere Else: Florida’s Own Evaluation Makes That Clear
We recently submitted public comments on Florida’s amendment to its Section 1115 waiver which has a medley of requests for the federal government to consider. On the plus side, the state is seeking to extend postpartum coverage from 60 days to 12 months (although it is unclear why they need a waiver). But on the […]
Retroactive Coverage Waivers: Coverage Lost and Nothing Learned
If you took cooking classes for more than two decades but still couldn’t boil water, wouldn’t you reconsider your lesson plan? Using section 1115 demonstrations, the Department of Health and Human Services (HHS) can grant states waivers of federal Medicaid requirements, if and only if, the waivers enable the states to conduct health coverage experiments […]
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 […]
