Summary
Section 1115 of the Social Security Act grants states the authority to design and implement experimental, pilot, or demonstration projects to test new approaches in Medicaid which deviate from current federal program rules and regulations. Since the Medicaid program began in 1965, these waivers have enabled states to expand coverage, change delivery systems, implement managed care, alter benefits and cost sharing, modify provider payments, and extend coverage in times of emergency.
As of December 2017, 34 states have 42 approved Section 1115 waiver programs in operation, and 22 waiver applications, sponsored by 20 states, are pending before the Centers for Medicare & Medicaid Services (CMS) for approval. Many propose program changes that have never before been approved in the history of the Medicaid program, and which reflect new guidance provided by the Trump Administration, consistent with a vision of broader Medicaid and entitlement reform.
The attached issue brief examines the recent changes to law and regulatory guidance governing Section 1115 waiver use, the waiver applications currently pending before CMS, and the implications for the Medicaid program going forward.