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 Waiver Trilogy: The Final Installment
The drama over Texas’ Section 1115 Medicaid waiver has come to a somewhat surprising and precipitous close. On April 22nd, 2022 the Biden Administration decided to stop fighting the litigation brought by Texas Attorney General Paxon to reinstate the terms of the Trump Administration’s waiver approval issued on January 15, 2021 (i.e. just a few […]
Now You See It, Now You Don’t: Supreme Court Drops Medicaid Work Requirements Case, But Still Does Damage
If you blinked at just the wrong moment last week, you might have missed that the Supreme Court erased several years of critical Medicaid law with just one 113-word order. Poof! On Monday, April 18th, the Supreme Court issued an order in the cases on appeal reviewing the legality of approvals of work requirements by […]
Texas Medicaid Section 1115 Waiver Drama Trilogy: Part II
Texas Expects to Get, But Not Give, Notice The Biden Administration came to town with clear intentions to review some of the waiver agreements that the Trump Administration had authorized – most notably on work requirements. We and others had urged the Trump Administration to reconsider the January 15th demonstration approval in Texas in light […]
Medicaid Wars: The Unwinding at the One Year Mark (Episode V)
In its first twelve months, the Biden administration has been unwinding the anti-Medicaid actions taken by its predecessor. The unwinding has been slow and methodical, and it is not yet finished. In part, this is because the new management at CMS has necessarily been focused on responding to the COVID-19 pandemic and in part because […]
California’s Medicaid Managed Care Waiver: New Potential for Access and Transparency
One of the most significant Medicaid managed care developments in 2021 happened on December 29, when CMS approved federal funding and waivers for California’s reform initiative, Advancing Innovation in Medi-Cal (CalAIM). The approval involved two sets of waivers, one operating under section 1115 of the Social Security Act, the other under section 1915(b)(4). For good […]
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 […]