Introduction
Section 1115 waivers give states the flexibility to innovate in their Medicaid programs, enabling them to test approaches that differ from federal requirements. These waivers allow states to address unique health challenges by expanding eligibility, enhancing benefits, and tackling social determinants of health (SDOH). This tracker provides a detailed overview of approved and pending Section 1115 waivers across states, with a focus on recent developments and the changing priorities of federal administrations. Understanding these waivers helps highlight how Medicaid can evolve to better meet the needs of vulnerable populations.
Understanding Section 1115 Waivers
What Are Section 1115 Medicaid Waivers?
Section 1115 waivers, authorized under the Social Security Act, allow states to implement experimental Medicaid programs that differ from standard federal Medicaid guidelines. These waivers encourage innovation, enabling states to tailor Medicaid to specific demographic needs, address budgetary constraints, and pilot new approaches to healthcare delivery. Section 1115 waivers can be “comprehensive,” involving broad changes across Medicaid programs, or “targeted,” focusing on specific populations or health initiatives.
Key Themes in Section 1115 Waivers
Main Goals of Section 1115 Waivers
Several key themes have emerged in approved and pending Section 1115 waivers, particularly under recent federal administrations. These themes reflect evolving priorities, from eligibility expansion to coverage of behavioral health services, and addressing social determinants of health.
Targeted Eligibility and Benefit Expansions
Expanding Eligibility and Benefits Through Waivers
One common use of Section 1115 waivers is to expand Medicaid eligibility to cover populations or services not traditionally included under standard Medicaid. Many waivers focus on expanding behavioral health benefits, allowing Medicaid to cover services provided in institutions for mental diseases (IMDs). This approach ensures that more people, particularly those in need of mental health or substance abuse treatment, have access to essential services.
Addressing Social Determinants of Health
Integrating Social Needs Into Medicaid
In recent years, Section 1115 waivers have increasingly focused on addressing Social Determinants of Health (SDOH) — non-medical factors such as housing, transportation, and food security that impact health outcomes. By addressing SDOH, states aim to reduce health disparities and improve overall health outcomes, especially for low-income populations.
State-Specific Section 1115 Waiver Examples
Comprehensive vs. Targeted Waivers Across States
Section 1115 waivers vary greatly from state to state, with some states implementing comprehensive waivers that overhaul Medicaid eligibility and benefits, while others focus on more specific populations or health issues.
Comprehensive Waivers
Broad Changes Across Medicaid Programs
Comprehensive waivers make sweeping changes to Medicaid, impacting eligibility, benefits, and provider payments. For example, a state may use a comprehensive waiver to expand Medicaid to low-income adults who would otherwise not qualify or to test new payment models aimed at improving care quality.
Targeted Waivers
Narrow Focus on Specific Populations or Issues
Targeted waivers address specific issues, such as providing behavioral health services for those with substance use disorders or ensuring continuity of coverage for children. These waivers are often implemented alongside other state initiatives to address urgent health challenges for distinct populations.
Evolution of Waiver Policies Across Administrations
How Federal Priorities Shape Section 1115 Waivers
The types of Section 1115 waivers approved and implemented are influenced by the priorities of the federal administration in power. Different administrations have used waivers to achieve policy goals that align with their healthcare agendas.
Waiver Policies Under the Trump Administration
Focus on Eligibility Requirements and Institutional Care
The Trump administration’s approach to Section 1115 waivers emphasized stricter eligibility requirements and introduced work requirements as a condition for Medicaid eligibility in some states. These policies aimed to encourage workforce participation among Medicaid recipients. Additionally, waivers under the Trump administration often included provisions for behavioral health services in institutional settings, such as substance use treatment in IMDs.
Biden Administration’s Focus on Expanding Coverage
Emphasis on Reducing Disparities and Expanding Access
The Biden administration has shifted Section 1115 waiver policies to expand access to Medicaid, emphasizing health equity and reducing health disparities. The administration withdrew approval for work requirements and phased out premium requirements, encouraging states to focus instead on waivers that expand coverage. Current waiver themes include addressing health-related social needs, offering pre-release Medicaid coverage for incarcerated individuals, and implementing multi-year continuous eligibility for children.
Current Status: Approved and Pending Waivers
Tracking the Latest Section 1115 Waiver Activity
The Medicaid Waiver Tracker monitors both approved and pending Section 1115 waivers across the U.S., providing updates on each state’s unique approach to Medicaid innovation. This tracker highlights how states tailor their Medicaid programs, expanding coverage and services for specific populations based on local needs and federal guidelines.
1. Approved Waivers: States with fully approved Section 1115 waivers can implement their initiatives as planned, with certain states receiving conditional approvals that include additional oversight requirements.
2. Pending Waivers: Pending waivers are under review by the Centers for Medicare & Medicaid Services (CMS). States with pending waivers are in the process of negotiating terms with CMS and may adjust proposals based on federal feedback.
Conclusion
Section 1115 Medicaid waivers play a crucial role in transforming Medicaid by allowing states to test innovative healthcare delivery and coverage models. By tracking approved and pending waivers, it becomes clear how states adapt Medicaid to fit their unique needs, from expanding behavioral health services to addressing social determinants of health. As Medicaid continues to evolve, Section 1115 waivers serve as an essential tool for states to drive health equity, address local health disparities, and ensure comprehensive care for vulnerable populations.
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FAQs
Q1: What is a Section 1115 waiver?
Ans: Section 1115 waivers allow states to test new approaches to Medicaid that differ from federal requirements, enabling innovative solutions to healthcare challenges.
Q2: How do Section 1115 waivers benefit Medicaid recipients?
Ans: These waivers help expand Medicaid eligibility, provide additional services (like behavioral health), and address social determinants of health to improve health outcomes.
