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.
Oregon Leads the Nation By Covering Children in Medicaid from Birth to Kindergarten – Which State Will Be Next??
The Biden Administration announced today that it will approve Oregon’s request to provide continuous Medicaid coverage to children from birth through age five and for two years for all Oregonians enrolled in Medicaid age six and up. This use of Section 1115 authority is precisely what Medicaid demonstrations are for — as we and colleagues […]
Coalition Recommends HHS Take Steps to Improve Medicaid Waiver Process
Section 1115 Medicaid waivers drive a large and growing share of Medicaid spending. Currently, 46 states and D.C. operate some or all of their Medicaid programs under section 1115 demonstration authority. Many of these waivers promote coverage; others undermine it, and in the process, the Medicaid program. Unfortunately, the federal regulations governing section 1115 waivers […]
Waiver Update: CMS May Have Found a Path Forward in Tennessee
The Biden CMS inherited a real waiver mess in Tennessee, but CMS may have found a path forward. CMS has asked the state to amend the most problematic parts of its section 1115 demonstration known as TennCare III, so that the TennCare program can continue. Just as importantly, to its credit (and unlike some other […]
Vermont’s Section 1115 Demonstration: Medicaid Managed Care Meets Single Payer
Vermont is one of ten states that don’t use risk-based Medicaid managed care. It’s not that Vermont isn’t interested in risk-based managed care. The state is very interested—so long as it is the managed care organization (MCO). The state made its case to CMS in its application to extend its section 1115 demonstration beyond June […]
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 […]