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.
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How H.R. 1 Cuts and Changes to Medicaid Played out in 2026 State Legislative Sessions (Part 2)
It’s been nearly a year since H.R.1 was signed into law, enacting the largest Medicaid cuts in history and setting off a scramble in state capitals to respond. Back in March, we took a look at how ten state legislatures were grappling with the impending budget holes and policies created by H.R.1. Now that most…
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Trump Administration Issues Section 1115 Medicaid Waiver Financing Guidance Which Goes Far Further Than H.R. 1 (Again)
On Friday, June 11 the Centers for Medicare and Medicaid Services (CMS) issued new guidance on the Secretary’s approach to implementing Section 1115(g) which was added to the Social Security Act by H.R. 1 – the President’s signature budget bill enacted last year. (Our explainer of the health provisions in the bill can be found…
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How are H.R. 1 Cuts and Changes to Medicaid and SNAP Playing out in 2026 State Legislative Sessions So Far?
Following the enactment of the largest Medicaid cuts in history, we anticipated a flurry of Medicaid activity in state legislative sessions. State legislators were left to fill the budget holes made by H.R.1, figure out how to implement H.R.1-mandated policies like work reporting requirements, and (hopefully) mitigate some of the associated coverage losses. Ten state…
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CMS Issues Final Rule Implementing H.R. 1’s Prohibition of Certain Uniformity Waiver Provider Taxes
On January 29, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing the H.R. 1 provision prohibiting certain “uniformity waiver” provider taxes that states use to support their Medicaid programs. (The rule is scheduled to be published in the Federal Register on February 2, 2026). Nearly all states use taxes…
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The Future of ACA’s Medicaid Expansion: What do Changes in HR1 Mean?
The federal budget reconciliation bill signed by President Trump, H.R. 1, made multiple cuts to the Medicaid program that were designed to deter states from expanding Medicaid. Ten states, mostly in the South, have not expanded Medicaid to low-income adults. Despite many attempts by proponents of large Medicaid cuts to lower the expansion match of…

