Medicaid Waiver Map

Use this interactive map to help you determine if your state has an 1115 Medicaid waiver and the impact on Medicaid beneficiaries living with or at risk for HIV and hepatitis. Please see NASTAD’s related Medicaid resources: Medicaid 1115 Waivers: Considerations for HIV and Hepatitis Programs and Medicaid 1115 Waivers: Exemptions for People Living with HIV and Hepatitis.

NASTAD’s interactive Private Insurance State Policy Tracker tool is available here.

This map was produced as part of a project supported by the Elton John AIDS Foundation.

Last Updated: July 15, 2020

Waiver Status

Pending

Both

Approved

Pending

Alaska

Approved

Alaska Substance Use Disorder and Behavioral Health Program

  • Status: Approved
  • Proposal would provide an enhanced set of mental health, behavioral health, and substance use treatment benefits. This component is still under review.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Federal Approval

Alabama

Pending

Alabama Medicaid Workforce Initiative

  • Status: Pending
  • Proposal would impose work requirements as a condition of eligibility for “able-bodied” adults age 19-59 in the low-income parents and caretakers and Transitional Medical Assistance (TMA) eligibility groups. Individuals who fail to meet work requirements will be disenrolled. Information about regaining eligibility will be provided in member notices.
  • State Resources
  • Federal Application (September 2018)
  • National Organization Comments on Alabama 1115 Waiver (October 2018)

Arkansas

Both

Arkansas Works 

  • Status: Approved
  • Premium assistance model for purchase of Qualified Health Plans for Medicaid expansion population.
  • UPDATE—February 14, 2020: A federal appeals court upheld the March 2019 decision, and ruled that the Arkansas waiver approval violated federal law.
  • UPDATE—March 27, 2019: Arkansas’ waiver has been invalidated following a lawsuit in federal court, on the grounds that HHS violated federal law when it approved the waiver without considering whether the waiver furthered the objectives of the Medicaid program. The waiver, which included work requirements, premiums, and other provisions, has been remanded to HHS to correct this error, and these provisions will not be implemented at this time.
  • State Resources
  • Federal Approval (March 2018) (NOTE: Pursuant to a May 14, 2019 notice from CMS, the state must adhere to the waiver special terms and conditions that were approved on December 8, 2016)
  • National Organization Comments on Loss of Coverage Resulting from Arkansas’ Section 1115 Waiver (November 2018)
  • National Organization Comments on Arkansas 1115 Waiver Amendments (August 2017)
  • NHeLP Comments on Arkansas 1115 Waiver Amendments (August 2016)

Arizona

Both

Arizona Health Care Cost Containment System 

  • Status: Amendment Pending
  • Requires premiums for expansion adults above 100% FPL through contributions to AHCCCS CARE account (similar to a Health Savings Account). Premiums and coinsurance liabilities are billed to members on a quarterly basis. Beneficiaries that make timely payments and engage in specified healthy behaviors related to preventive health and/or chronic disease management will be exempt from premiums for six months. Members may access funds in AHCCCS CARE account upon completion of healthy behaviors. Disenrollment for failure to pay premiums, but no lockout for re-enrollment.
  • Enacts payment and delivery reforms to improve behavioral health services, including incentive payments to providers for increasing physical and behavioral health care integration and coordination.
  • “Medically frail” individuals are exempt from premiums. The state has proposed to develop a definition of “medically frail” that specifically includes people living with HIV, but has not yet done so.
  • The state has received Appendix K approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • Proposed amendment would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • REJECTED: CMS rejected the state’s proposal to impose a five-year lifetime coverage limit for individuals who fail to comply with work requirements.
  • UPDATE—October 17, 2019: Arizona has postponed implementation of work requirements until further notice, citing the “evolving national landscape concerning Medicaid community engagement programs” and ongoing litigation in several other states regarding this topic. Arizona previously received federal approval to implement work requirements for “able-bodied” expansion adults age 19-49, with exemptions for “medically frail” individuals, with disenrollment and two-month lockout for failure to comply. Work requirements were set to take effect no earlier than January 2020.
  • State Resources
  • Federal Approval
  • Federal Application (May 2017)
  • National Organization Comments on Arizona 1115 Waiver Amendment (May 2018)
  • National Organization Comments on Arizona 1115 Waiver Amendment (February 2018)
  • HIV Health Care Access Working Group Comments on Arizona 1115 Waiver (December 2015)

California

Pending

Medi-Cal 2020 Demonstration

  • Status: Amendment Pending
  • Waiver began as "Bridge to Reform" to allow for early Medicaid expansion for Medi-Cal beneficiaries as well as payment and delivery reform initiatives. The waiver allowed the state to incorporate people with disabilities into the Medi-Cal managed care system and supported a range of projects aimed at improving care at safety net and public hospitals.
  • “Health home” initiative allows the state to offer care coordination services to beneficiaries with chronic conditions in managed care plans. Health home services may be provided by community health workers.
  • Authorizes pilot program programs to support infrastructure development to integrate services for enrollees with mental health or substance use disorders.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • Federal Application (February 2020)
  • National Organization Comments on California's 1115 Waiver (October 2011)

Colorado

Pending

Expanding the Substance Use Disorder Continuum of Care

  • Status: Pending
  • Proposal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Application (October 2019)

Connecticut

No Waiver

District of Columbia

Approved

D.C Behavioral Health Transformation

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • State Resources
  • Federal Approval

Delaware

Approved

Diamond State Health Plan 

  • Status: Approved
  • Eliminates retroactive eligibility for most populations.
  • Expands community-based behavioral health services.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Florida

Approved

Florida Managed Medical Assistance Program 

  • Status: Approved
  • Provides coverage for individuals diagnosed with AIDS with income at or below 222% FPL and assets not exceeding $2,000 (for an individual).
  • Enrolls people living with HIV or AIDS in specialty plans, where available.
  • Eliminates retroactive coverage.
  • Includes community behavioral health providers as participating providers under the Low Income Pool.
  • Authorizes a pilot program to provide behavioral health and supportive housing assistance services for enrollees age 21 and older with serious mental illness and/or substance use disorder who are homeless or at risk of homelessness due to disability.
  • State Resources
  • Federal Approval
  • National Organization Comments on Florida 1115 Waiver Amendment (June 2018)

Georgia

Pending

Georgia Pathways to Coverage

  • Status: Pending
  • Proposal would implement partial expansion for adults age 19-64 up to 100% FPL who are already working participating in work-related activities for 80 hours per month. The state’s waiver application does not provide for any exemptions for applicants who do not meet the work requirements upon their initial application. Applicants with incomes above 50% FPL must also make an initial premium payment before their coverage can begin.
  • Proposal would impose work requirements as a condition of eligibility. Individuals who fail to meet work requirements will be disenrolled with lockout until compliance is achieved. Members with evidence of meeting work requirements for six consecutive months will be exempt from reporting compliance, but are required to report changes in employment status. Members who are exempt from reporting requirements who fail to report changes in employment status are liable for all incurred capitation rate and cost-sharing expenses paid on the member’s behalf. Applicants must demonstrate compliance with work requirements in order to gain coverage.
  • Proposal would implement Member Rewards Accounts (similar to a Health Savings Account) for enrollees with incomes at or above 50% FPL. Accounts are funded with enrollee premiums, as well as with state funds healthy incentive “points.” Account balances may be used to cover copayments, certain health-related expenses not covered by Medicaid (such as over-the-counter drugs, dental services, glasses, etc.), or post-Medicaid health-related expenses for members who leave Medicaid because their income increased above 100% FPL.
  • Proposal would implement premiums for enrollees with incomes at or above 50% FPL, through contributions to a Member Rewards Account. Enrollees will be suspended after two months of non-payment and disenrolled after three months of non-payment. If an enrollee is disenrolled for non-payment of premiums, the state may seek to recoup capitation payments from the months during which the enrollee was suspended.
  • Proposal would implement copayments for enrollees with incomes at or above 50% FPL. Copayment are not paid to providers at the point of service, but are instead assessed retrospectively for services already received. Copayments are deducted from Member Rewards Accounts, which may result in a negative balance if the account has insufficient funds. Future premium payments and healthy incentive points will be applied to the balance.
  • Proposal would eliminate retroactive eligibility.
  • Proposal would allow for waiting periods. Enrollment begins at the start of the month following the initial premium payment. Enrollees who are not required to pay premiums must wait until the start of the month following enrollment. Applicants must also demonstrate compliance with work requirements in order to gain coverage.
  • Proposal would eliminate hospital presumptive eligibility.
  • State Resources
  • Federal Application (December 2019)

Hawaii

Approved

Hawaii QUEST Integration 

  • Status: Approved
  • Provides community integration services for qualified beneficiaries who meet the definition of being chronically homeless and who also have a behavioral or physical illness or a substance abuse diagnosis.
  • The state has received Appendix K approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • State Resources
  • Federal Approval

Hawaii COVID-19 Public Health Emergency Demonstration

  • Status: Approved
  • Authorizes the state to modify certain assessments and deadlines for beneficiaries receiving HCBS services.
  • Modifies HCBS visitor requirements to minimize the spread of COVID-19.
  • Authorizes retainer payments for certain providers.
  • NOTE: This 1115 waiver will terminate upon termination of the COVID-19 public health emergency.
  • Federal Approval

Iowa

Pending

Iowa Wellness Plan 

Idaho

Both

Idaho Medicaid Reform Waiver

 Idaho Behavioral Health Transformation

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • NHeLP Comments on Idaho 1115 waiver (February 2020)

Illinois

Both

Illinois Behavioral Health Transformation

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Authorizes 10 SUD pilot projects that provide case management, withdrawal management, peer recovery, tenancy support, and other services to various populations in need of SUD care.
  • Expands community-based behavioral health benefits.
  • State Resources
  • Federal Approval
  • AIDS Foundation of Chicago Comments on Illinois 1115 Waiver (November 2016)

 Illinois Continuity of Care and Administrative Simplification

  • Status: Pending
  • Proposal would extend postpartum Medicaid coverage from 60 days to 12 months.
  • Proposal would allow managed care reinstatement within 90 days when a Medicaid beneficiary submits late redetermination paperwork, rather than requiring reinstatement into fee-for-service prior to going through the managed care enrollment process again, in order to reduce churn between fee-for-service and managed care.
  • Proposal would delay implementation of hospital presumptive eligibility.
  • State Resources
  • Federal Application (January 2020)

Indiana

Pending

Healthy Indiana Plan (HIP) 2.0 

  • Status: Renewal and Amendment Pending
  • Establishes premiums through monthly contributions to a Personal Wellness and Responsibility (POWER) account (similar to a Health Savings Account). Disenrollment with 6-month lockout for failure to pay premiums (>100% FPL only). Premiums are optional for beneficiaries with incomes below 100% FPL, but those who do not pay premiums get fewer benefits and must pay cost-sharing charges.
  • Eliminates non-emergency medical transportation.
  • Eliminates retroactive coverage for non-pregnant HIP program enrollees.
  • Allows for waiting periods.
  • Imposes 50% tobacco premium surcharge.
  • Disenrollment with lockout for failure to complete annual redetermination on time. Enrollees have 90 days following disenrollment to submit redetermination paperwork and re-enroll. Failure to complete redetermination during this 90-day period results in additional 3-month lockout.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • HIV and “chronic” hepatitis B and C included in medically frail condition list, but exemption may not be automatic. Medically frail are exempt from work requirements, lockout periods, and non-emergency medical transportation waiver.
  • Provides a $1,000 account, funded from aggregate remaining balances of HIP $2,500 POWER Accounts, to cover premiums and out-of-pocket costs for a 12-month period for enrollees who must transition from Medicaid to commercial insurance due to an increase in income. This was approved through the state’s ESRD Waiver, which is currently set to expire on December 31, 2020 (a renewal is currently pending).
  • UPDATE—October 31, 2019: Indiana has temporarily suspended the work reporting requirements due to a pending lawsuit in federal court. Members who fail to report compliance with work requirements will not have their eligibility suspended at this time. Indiana previously received approval to implement work requirements as a condition of eligibility for “able-bodied” adults age 19-59 in the Medicaid expansion, low-income parents and caretakers, and Transitional Medical Assistance (TMA) eligibility groups, with lockout until next redetermination for failure to comply.
  • State Resources
  • Federal Approval
  • Federal Application (January 2020)
  • Federal Application (July 2019)
  • National Organization Comments on Indiana’s Request to Amend 1115 Waiver Extension Request (July 2017)
  • NHeLP Comments on Indiana’s SMI/SED 1115 Amendment Request (October 2019)
  • NHeLP Comments on Indiana’s 1115 Waiver Amendments (September 2019)
  • NHeLP Comments on Indiana’s Request to Amend 1115 Waiver Extension Request (July 2017)
  • National Organization Comments on Indiana 1115 Waiver Extension Request (March 2017)
  • National Organization Comments on Evaluation and Lockout Provisions of Indiana 1115 Waiver (January 2016)
  • HIV Health Care Access Working Group Comments on Indiana 1115 Waiver (September 2014)

Kansas

Pending

KanCare 2.0 

  • Status: Amendment Pending
  • Authorizes rehabilitation services designed to meet the more intensive needs of individuals with SUD in their community and avoid the need for inpatient hospitalization. Services are prior authorized and include various detox, treatment, and community-based services.
  • Expands community-based behavioral health benefits.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • DEFERRED: The state has asked CMS to defer consideration of proposals to impose work requirements and to limit coverage for TMA enrollees.
  • REJECTED: CMS rejected the state’s proposal to impose a 36-month lifetime coverage limit for individuals who are subject to work requirements.
  • State Resources
  • Federal Approval
  • Federal Application (May 2018)
  • NHeLP Comments on Kansas 1115 Waiver Renewal (January 2018)
  • National Organization Comments on Kansas 1115 Waiver Extension Request (January 2018)

Kentucky

Approved

Kentucky HEALTH 

Louisiana

Approved

Healthy Louisiana OUD/SUD Demonstration

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Federal Approval

Massachusetts

Pending

MassHealth 

  • Status: Amendment Pending
  • Shifts certain Medicaid populations into 1115 demonstration, including PLWH with income at or below 200% FPL.
  • Expands eligibility, with some limits on benefits, for PLWH with incomes between 133 and 200% FPL who would be eligible for Medicaid expansion but for their income. Enrollees may choose to receive premium assistance for ESI (with wraparound) in lieu of direct coverage.
  • PLWH with income above 133% FPL do not receive EPSDT services or non-emergency medical transportation, and may be subject to waiting list.
  • Discontinues provisional eligibility for certain adults. PLWH with incomes at or below 200% FPL may self-attest to income eligibility and receive 90-day provisional eligibility.
  • Extends Massachusetts’ longstanding 1115 waiver to move to an Accountable Care Organization model. The ACO model incentivizes partnership between ACOs and community-based organizations to improve behavioral care and long-term services and supports in particular.
  • Establishes a DSRIP program to incentivize investment to address social determinants of health.
  • Expands benefits to address the opioid epidemic.
  • Provides subsidies for individuals under 300% FPL who are not eligible for Medicaid and who purchase Marketplace coverage.
  • Allows the state to consider family income and resources “not actually made available to the applicant,” as well as income from any member of the “family unit,” when determining income for eligibility purposes.
  • Limits retroactive eligibility to 10 days prior to application date for most eligibility groups.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • Proposed amendment would expand existing authority to provide services delivered in IMDs to include medically necessary treatment for co-occurring mental health conditions.
  • Proposed amendment seeks partial expansion to 100% FPL, and would shift coverage for ACA expansion adults and non-disabled parents and caretakers to subsidized Exchange plans (>100% FPL) or 1115 demonstration (<100% FPL) depending on income. PLWH who were eligible for MassHealth prior to ACA would remain eligible for Medicaid.
  • Proposed amendment would eliminate non-emergency medical transportation, except for SUD services.
  • Proposed amendment would eliminate emergency Medicaid for immigrants who are eligible for subsidized coverage with a $0 premium and nominal cost-sharing through the Exchange.
  • Proposed amendment would implement cost-sharing limit (5% of aggregate household income) on an annual basis rather than a quarterly or monthly basis.
  • REJECTED: CMS rejected the state’s request to impose a closed formulary.
  • State Resources
  • Federal Approval
  • Federal Application (September 2017)
  • National Organization Comments on Massachusetts 1115 Waiver Amendments (October 2017)
  • NHeLP Comments on Massachusetts 1115 Waiver Amendments (October 2017)

Maryland

Approved

Maryland Health Choice

  • Status: Approved
  • Authorizes a pilot program to integrate physical and behavioral health services in primary care settings for a limited number of beneficiaries.
  • Authorizes SUD treatment services for residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Maine

Both

Maine Section 1115 Demonstration for Individuals Living with HIV/AIDS 

  • Status: Approved
  • Provides coverage for PLWH with incomes at or below 250% FPL.
  • Enrollees with incomes at or below 133% FPL who are eligible for MaineCare receive Medicaid state plan-covered services and case management services.
  • Enrollees with incomes at or below 250% FPL who are not eligible for MaineCare receive a targeted essential set of services. The benefits provided to this group are not recognized as Minimum Essential Coverage under the ACA.
  • State Resources
  • Federal Approval

 Maine Substance Use Disorder Care Initiative

  • Status: Pending
  • Proposal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Application (November 2019)

Michigan

Approved

Healthy Michigan 

  • Status: Approved
  • Imposes work requirements for “able-bodied” adults age 19-62, with disenrollment and one-month lockout for failure to comply for more than 3 months in a 12-month period. Re-enrollment contingent upon proof of compliance. Work requirements go into effect January 2020.
  • Requires compliance with “healthy behaviors” or completion of a health risk assessment as a condition of eligibility for individuals with income above 100% FPL and at least 48 months of cumulative enrollment, with disenrollment for failure to comply. Re-enrollment is contingent upon completion of a health risk assessment.
  • Imposes monthly premiums for enrollees with incomes above 100% FPL in the form of contributions to MI Health Account (similar to a health savings account), with reduced premiums upon completion of “healthy behaviors.” After 48 cumulative months of enrollment, members with income above 100% FPL will no longer be required to pay copayments; however, their premiums will increase, they will not be eligible for healthy behavior premium reductions, and they can be disenrolled for failure to pay. Re-enrollment is contingent upon payment of past due premiums.
  • Imposes targeted cost-sharing for all enrollees in the Healthy Michigan Plan, with reduced copayments upon completion of “healthy behaviors.” Copayment liabilities are billed to members on a quarterly basis. Members with income above 100% FPL and at least 48 months of cumulative enrollment are not required to pay copayments, but their premiums will increase.
  • Allows requests for prior authorization for prescription drugs to be addressed within 72 hours for individuals enrolled in Marketplace premium assistance. A 72-hour supply must still be provided in the event of emergency.
  • Eliminates copayments for services related to treatment of HIV or viral hepatitis.
  • HIV is included in the medically frail condition list. Medically frail are exempt from work requirements, premiums, and the 48-month cumulative enrollment loss of coverage provisions.
  • UPDATE—September 23, 2019: Michigan has postponed implementation of premium and healthy behavior requirements until October 1, 2020.
  • State Resources
  • Federal Approval
  • National Organization Comments on Michigan 1115 Waiver Amendment (October 2018)
  • National Organization Comments on Michigan 1115 Waiver (October 2015)
  • National Organization Comments on Michigan 1115 Waiver (December 2013)

 Michigan 1115 Behavioral Health Demonstration

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Minnesota

Approved

Minnesota Substance Use Disorder System Reform

  • Status: Approved
  • Authorizes intensive outpatient SUD services not otherwise covered under the state plan.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Missouri

Pending

Missouri Gateway to Better Health

  • Status: Amendment Pending
  • Authorizes limited outpatient SUD services for the demonstration population.
  • Clarifies that the Medicaid rebate requirements of Section 1927 do not apply to the limited prescription drug benefit provided under Gateway to Better Health.
  • State Resources
  • Federal Approval
  • Federal Application (October 2019)

Mississippi

Pending

Mississippi Medicaid Workforce Training Initiative

Montana

Both

Montana Health and Economic Livelihood Partnership (HELP) 

  • Status: Renewal and Amendment Pending
  • Authorizes 12 months of continuous coverage for the Medicaid expansion population.
  • Imposes premiums for individuals with income 50-133% FPL. Individuals with income above 100% FPL may be disenrolled for failure to pay premiums, with lockout until the end of the calendar quarter or upon payment of outstanding premiums.
  • Uses an Alternative Benefit Plan for the expansion population with defined provider network.
  • Proposed renewal/amendment would impose work requirements for non-exempt expansion adults age 19-55, with disenrollment and six-month lockout for failure to comply.
  • Proposed renewal/amendment would gradually increase premiums based on the length of time an enrollee is enrolled in the program, capped at four percent of aggregate household income.
  • State Resources
  • Federal Approval
  • Federal Application (August 2019)
  • National Organization Comments on Montana HELP Program 1115 Waiver (October 2015)

North Carolina

Approved

North Carolina's Medicaid Reform Demonstration 

 North Carolina COVID-19 Public Health Emergency Demonstration

  • Status: Approved
  • Authorizes the state to expedite eligibility for long-term care services and supports (LTSS) by accepting self-attestation or alternative verification for certain eligibility requirements.
  • Authorizes the state to delay certain assessments for beneficiaries receiving LTSS services.
  • Authorizes retainer payments for certain providers.
  • NOTE: This 1115 waiver will terminate upon termination of the COVID-19 public health emergency.
  • Federal Approval

North Dakota

No Waiver

Nebraska

Pending

Nebraska Substance Use Disorder Section 1115 Demonstration

New Hampshire

Approved

New Hampshire Granite Advantage Health Care Program

 New Hampshire Building Capacity for Transformation 

  • Status: Approved
  • Enacts payment and delivery reforms to improve behavioral health services, including integrating behavioral and physical health, expanding behavioral health provider capacity, and expanding care coordination services.
  • Uses DSRIP funding to form regionally based Integrated Delivery Networks to incentivize partnership between behavioral health care providers and community-based providers.
  • State Resources
  • Federal Approval

New Hampshire SUD Treatment and Recovery Access

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

New Hampshire COVID-19 Public Health Emergency (PHE) Demonstration

  • Status: Approved
  • Authorizes retainer payments for certain providers.
  • NOTE: This 1115 waiver will terminate upon termination of the COVID-19 public health emergency.
  • State Resources
  • Federal Approval

New Jersey

Pending

New Jersey FamilyCare Comprehensive Demonstration

  • Status: Amendment Pending
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • The state has received Appendix K approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • Proposed amendment would extend postpartum Medicaid coverage.
  • State Resources
  • Federal Approval
  • Federal Application (February 2020)

New Mexico

Approved

Centennial Care 2.0

  • Status: Approved
  • Access to expanded benefits for individuals who complete “healthy behaviors.”
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • In February 2020, CMS approved an amendment to eliminate the following previously approved waivers: premiums, copayments for non-emergency use of the hospital emergency department and non-preferred prescription drugs, and elimination of retroactive eligibility.
  • State Resources
  • Federal Approval
  • National Organization Comments on New Mexico 1115 Waiver (January 2018)

Nevada

No Waiver

New York

Pending

New York Medicaid Redesign Team 

Ohio

Approved

Ohio Group VIII Work Requirements and Community Engagement Section 1115 Demonstration Waiver

  • Status: Approved
  • Imposes work requirements as a condition of eligibility for expansion adults ages 19-49, with disenrollment for failure to comply. Enrollees may re-enroll at any time with no lockout period.
  • Exempts individuals with chronic conditions participating in the Specialized Recovery Services (SRS) Program, which includes people living with HIV who also have a serious mental illness.
  • State Resources
  • Federal Approval

 Ohio Section 1115 Demonstration Waiver for Substance Use Disorder Treatment

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Oklahoma

Pending

Oklahoma SoonerCare 

  • Status: Amendments Pending
  • SoonerCare Choice program: primary care case management delivery system with patient-centered medical home model.
  • Insure Oklahoma: premium assistance program (including Employer-Sponsored Insurance program and Individual Program) for individuals who do not qualify for SoonerCare or SoonerCare Choice.
  • Eliminates retroactive coverage for certain eligibility groups.
  • Eliminates EPSDT for full time college students age 19 through 22 with incomes above 200% FPL.
  • Eliminates non-emergency transportation for certain eligibility groups.
  • State Resources
  • Federal Approval
  • Federal Application (May 2020)
  • Federal Application (December 2018)
  • Federal Application (March 2016)
  • National Organization Comments on Oklahoma 1115 Waiver Amendment (January 2019)

 Oklahoma SoonerCare 2.0

  • Status: Pending
  • Proposal would apply primarily to the expansion group. Medicaid expansion goes into effect on October 1, 2020.
  • Proposal would impose work requirements, phased in over a 12-month period, for enrollees age 19-60 with disenrollment for failure to comply and lockout until compliance is achieved. Proposal would allow the state to modify hour requirements, exemptions, and qualifying activities without seeking federal approval.
  • Proposal would impose premiums for enrollees with incomes over the parent/caretaker income eligibility cutoff (about 40% FPL). Enrollees will be disenrolled for failure to pay premiums, but may re-enroll any time with no lockout period.
  • Proposal would allow for waiting periods by delaying enrollment for individuals with a premium obligation until after the initial premium payment is made. Enrollees who fail to make the initial premium payment within three months of initial enrollment will be disenrolled, but may re-enroll any time with no lockout period.
  • Proposal would discontinue EPSDT benefits for 19- and 20-year-olds.
  • Proposal would eliminate non-emergency medical transportation.
  • Proposal would eliminate retroactive eligibility.
  • Proposal would eliminate hospital presumptive eligibility.
  • Proposal would authorize capped “block grant” funding.
  • Proposal would exempt enrollees who are “physically or mentally unable to work” from work requirements.
  • Proposal would exempt some members from premiums. Exemptions include people living with HIV/AIDS, substance use disorder, and serious mental illness.
  • State Resources
  • Federal Application (May 2020)

Oklahoma Institutions for Mental Disease Waiver for Serious Mental Illness/Substance Use Disorder

  • Status: Pending
  • Proposal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Application (June 2020)

Oregon

Pending

Oregon Health Plan Substance Use Disorder 1115 Demonstration

  • Status: Pending
  • Proposal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Application (May 2020)

Pennsylvania

Approved

Pennsylvania Medicaid Coverage Former Foster Care Youth From a Different State SUD Demonstration

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Rhode Island

Approved

Rhode Island Comprehensive Demonstration

 

South Carolina

Approved

South Carolina Healthy Connections Works

  • Status: Approved
  • Imposes work requirements as a condition of eligibility for non-disabled adults under age 65 in the low-income parents and caretakers and Transitional Medical Assistance (TMA) eligibility groups, with up to three-month lockout for failure to comply.
  • State Resources
  • Federal Approval

 South Carolina Palmetto Pathways to Independence

  • Status: Approved
  • Provides Medicaid coverage for parents and caretakers with incomes up to 100% FPL and certain “Targeted Adults” (“chronically homeless” individuals with incomes up to 5% FPL, justice-involved individuals in need of substance use or mental health treatment with incomes up to 100% FPL, and individuals in need of substance use treatment with incomes up to 100% FPL). Enrollment for Targeted Adults is limited to 12 months, unless the enrollee continues to be actively engaged in SUD treatment at the end of the 12-month period.
  • Authorizes the state to cap enrollment for the Targeted Adult Group.
  • Imposes work requirements for all populations included in the waiver, with disenrollment for failure to comply and lockout until compliance is achieved. Applicants must be in compliance with work requirements at the time of application to be enrolled.
  • State Resources
  • Federal Approval

South Dakota

Pending

South Dakota Career Connector

  • Status: Pending
  • Proposal would impose work requirements as a condition of eligibility for adults age 19-59 in the low-income parents and caretakers and Transitional Medical Assistance (TMA) eligibility groups in two counties. Individuals who fail to meet work requirements will be disenrolled.

Tennessee

Pending

TennCare II

 

Texas

No Waiver

Utah

Both

Utah Primary Care Network 

  • Status: Amendments Pending
  • Expands Medicaid to adults up to 138% FPL at the enhanced federal match rate.
  • Imposes work requirement as a condition of eligibility for expansion adults age 19-64, with disenrollment for failure to comply and lockout until compliance is achieved.
  • Provides full state benefits for adults without dependent children with income at 0% FPL who are chronically homeless, involved in the criminal justice system, or in need of SUD or mental health treatment (“Targeted Adults” group).
  • Eliminates retroactive coverage for certain enrollees.
  • Eliminates non-emergency medical transportation for certain enrollees.
  • Weakens EPSDT benefits for 19- and 20-year-olds in certain eligibility groups.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands dental services to certain adults with income at 0% FPL who are receiving SUD treatment.
  • Authorizes clinically managed residential withdrawal management services, referred to as “social detoxification,” to Medicaid-eligible adults in Salt Lake County.
  • Exempts enrollees who are “physically or mentally unable to work” from work requirements.
  • Proposed amendment would eliminate hospital presumptive eligibility.
  • Proposed amendment would impose premiums for enrollees with incomes above 100% FPL.
  • Proposed amendment would provide Medicaid coverage for justice-involved individuals with a chronic physical or behavioral health condition, mental illness, or opioid use disorder in the 30-day period immediately prior to release from a correctional facility.
  • REJECTED: CMS rejected the state’s request to receive the enhanced federal match rate for partial expansion. The enhanced match is unavailable for waivers that limit enrollment in the new adult group, either by implementing an income cutoff of less than 138% FPL or through an enrollment cap.  
  • REJECTED: CMS rejected the state’s request to implement an enrollment cap for the expansion population.
  • State Resources
  • Federal Approval
  • Federal Application (June 2020)
  • Federal Application (November 2019)
  • Federal Application (August 2017)
  • NHeLP Comments on Utah 1115 Waiver Amendment (December 2019)
  • National Organization Comments on Utah 1115 Waiver Amendment (August 2018)
  • National Organization Comments on Utah 1115 Waiver Extension Amendments (September 2017)
  • NHeLP Comments on Utah 1115 Waiver Extension Amendments (September 2017)

 Utah Per Capita Cap 1115 Demonstration

  • Status: Pending
  • Proposal would authorize a per capita cap funding mechanism for the expansion group, which will include the “Targeted Adults” group.
  • Proposal would impose work requirements for the Medicaid expansion population.
  • Proposal would eliminate hospital presumptive eligibility.
  • REJECTED: CMS rejected the state’s request to receive the enhanced federal match rate for partial expansion. The enhanced match is unavailable for waivers that limit enrollment in the new adult group, either by implementing an income cutoff of less than 138% FPL or through an enrollment cap. 
  • State Resources
  • Federal Application (August 2019)

Virginia

Approved

Building and Transforming Coverage, Services, and Supports for a Healthier Virginia

Vermont

Approved

Vermont Global Commitment to Health 

  • Status: Approved
  • Authorizes premium subsidies for individuals enrolled in a QHP with incomes at or below 300% FPL.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • The state has received Appendix K approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • State Resources
  • Federal Approval

Washington

Pending

Washington Medicaid Transformation Project

  • Status: Amendment Pending
  • Establishes Accountable Communities of Health (ACHs) comprised of clinical and community service providers to lead projects including capacity building, care delivery redesign, and prevention and health promotion for Medicaid beneficiaries.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed amendment would expand access to inpatient and short-term mental health treatment.
  • State Resources
  • Federal Approval
  • Federal Application (April 2020)

 Washington COVID-19 Public Health Emergency

  • Status: Approved
  • Authorizes the state to expedite eligibility for long-term care services and supports (LTSS) by accepting self-attestation or alternative verification for certain eligibility requirements.
  • Authorizes the state to delay certain assessments for beneficiaries receiving LTSS services.
  • Authorizes increased payments for certain providers.
  • Authorizes retainer payments for certain providers.
  • NOTE: This 1115 waiver will terminate upon termination of the COVID-19 public health emergency.
  • Federal Approval

Wisconsin

Approved

Wisconsin BadgerCare Reform 

  • Status: Approved
  • Authorizes state to implement partial expansion by providing benefits to non-pregnant childless adults ages 19-64 with incomes at or below 100% FPL. “Childless” adults may have children, but do not live with children under age 19.
  • Imposes premiums for individuals with incomes above 50% FPL, with disenrollment and 6-month lockout for failure to comply. Premiums may be reduced for individuals who do not engage in “health risk behaviors,” including alcohol consumption and illicit drug use. Early re-enrollment permitted upon payment of past due premiums.
  • Imposes work requirements as a condition of eligibility for adults ages 19-49.
  • Imposes 48-month enrollment time limit, followed by 6-month lockout, for enrollees subject to work requirements. Months in which the individual meets work requirements do not count towards the 48-month limit.
  • Requires completion of health risk assessment as a condition of eligibility.

 Wisconsin Senior Care 

  • Status: Approved
  • Provides comprehensive prescription drug benefits to Wisconsin residents age 65+ with income at or below 200% FPL who are not otherwise eligible to receive full Medicaid benefits.
  • State Resources
  • Federal Approval

West Virginia

Approved

West Virginia Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorder 

  • Status: Approved
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD
  • Federal Approval

Wyoming

No Waiver

Guam

No Waiver

Northern Mariana Islands

No Waiver

American Samoa

No Waiver

Puerto Rico

No Waiver

Marshall Islands

No Waiver

Palau

No Waiver

Federated States of Micronesia

No Waiver

Virgin Islands

No Waiver

Premiums

Yes
No

Work Requirements

Yes
No

Enrollment Time Limit/Lifetime Cap

Yes
No

SUD/Behavioral Health

Yes
No

HIV- or Hepatitis-Specific Exemptions

Yes
No

Medicaid Waiver Map – Background Information

What is a Medicaid 1115 Waiver?

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve demonstration projects that promote the objectives of the Medicaid program. To encourage innovative demonstration projects, section 1115 gives states additional flexibility to “waive” certain federal Medicaid requirements.  An 1115 waiver or demonstration project typically lasts for five years (with the option to renew). Demonstration projects must also be “budget neutral” to the federal government, meaning that during the course of the project, the federal Medicaid expenditures cannot be more than federal spending would have been without the project.

What Kinds of Things Can States Do with an 1115 Waiver?

States have used the flexibility provided through 1115 waivers for a number of different purposes, including to:

  • Implement the Medicaid expansion in an innovative way, for instance through purchase of Qualified Health Plans for the Medicaid expansion population
  • Expand services for a particular population, for instance, substance use disorder services to better address the opioid epidemic
  • Test innovative ways to pay for and deliver care, for instance through expansion of the types of providers eligible to seek Medicaid reimbursement or programs that incentivize partnerships between hospital systems and community and public health providers to improve individual and population health 
  • Impose additional eligibility requirements, such as work requirements, increased cost-sharing, monthly premiums, and lifetime enrollment caps
  • Expand eligibility for family planning services, for instance, by increasing the income threshold and expanding the program to men as well as women

How Do Medicaid 1115 Waivers Impact HIV and Hepatitis Prevention Programs?

Because 1115 waivers can be used to develop innovative approaches to population health, with an emphasis on prevention, there may be reimbursement opportunities for HIV prevention services included in these types of waivers. For instance, some waivers have been used to cover services provided by Community Health Workers and other peer workers or to cover HIV linkage services. Waivers are also being used to increase drug user health services and address the opioid epidemic and could include new opportunities for partnerships with HIV and hepatitis public health programs. 

How Can I Weigh in with My State or the Federal Government During the 1115 Waiver Approval Process?

There are a number of transparency and notice and comment requirements that must precede 1115 waiver approval. At the state level, states must post all 1115 waiver applications on the state Medicaid website and provide a public comment period to solicit input from interested parties. This often includes public hearings and listening sessions to discuss the proposal and solicit feedback. Following the state notice and comment process, the application is submitted for federal review by CMS, where it is posted on the CMS website and subject to another notice and comment period from interested parties. Public health stakeholders should weigh in at all stages of the 1115 waiver application process to ensure that proposals protect access to care and prevention services for people living with and at risk for HIV and hepatitis.  

Glossary

  • ACO: Accountable Care Organizations are groups of providers (e.g., doctors, hospitals, community health centers) that receive financial incentives to work together to provide coordinated care across provider types and settings for patients
  • ACH: Accountable Communities of Health are similar to ACOs and bring together clinical providers as well as social services programs and providers to provide patient-centered care that addresses health care needs as well as social determinants of health
  • CHIP: The Children’s Health Insurance Program provides coverage to eligible children through Medicaid or a separate program. Like Medicaid, it is administered by states subject to federal rules and jointly funded by states and the federal government
  • CMS: The Centers for Medicare and Medicaid Services is the federal agency that oversees the Medicaid program
  • DSRIP: Delivery System Reform Incentive Plans are a type of 1115 waiver states may use to restructure the way they deliver and pay for Medicaid and other safety net health services
  • FPL: Federal poverty level, a federal income threshold used to determine eligibility for public programs that are based on financial need
  • MCO: Managed Care Organizations are entities that serve Medicaid beneficiaries through a network of providers through a financial and contractual arrangement with the state Medicaid program
  • Premium Assistance: A Medicaid option that allows states to use Medicaid funding to purchase commercial insurance for eligible beneficiaries on the private market (as opposed to through the traditional Medicaid fee-for-service or managed care systems)

What Other Resources Are There on 1115 Waivers?