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.

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

Last Updated: September 2018

Waiver Status

Approved

Pending

Both

Pending

Alaska

Pending

Alaska Medicaid Section 1115 Behavioral Health Demonstration

  • Status: Pending
  • Proposal would provide an enhanced set of mental health, behavioral health, and substance use treatment benefits.
  • Proposal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Federal Application (January 2018)

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.
  • State Resources
  • Federal Application (September 2018)

Arkansas

Approved

Arkansas Works

  • Status: Approved
  • Imposes work requirements for "able-bodied" expansion adults ages 19-49, with disenrollment and lockout through the end of the coverage year for failure to comply.
  • Premium assistance model for purchase of Qualified Health Plans for Medicaid expansion population.
  • Eliminates premium assistance for employer-sponsored coverage.
  • Requires premiums for beneficiaries with income above 100% FPL; with penalties for non-payment, including reduction in available cost-sharing assistance or a reduced state tax return. Enrollees who make timely payments may receive additional benefits.
  • Limits retroactive coverage to 30 days prior to the date of application.
  • Allows requests for prior authorization for prescription drugs to be addressed within 72 hours, with expedited review within 24 hours only in exigent circumstances. A 72-hour supply must still be provided in the event of emergency.
  • State Resources
  • Federal Approval
  • National Organization Comments on Arkansas 1115 Waiver Amendment (August 2017)
  • NHeLP Comments on Arkansas 115 Waiver Amendments (August 2017)

Arizona

Pending

Arizona Health Care Cost Containment System

  • Status: Amendment Pending
  • Requires premiums for expansion adults above 100% FPL through monthly contributions to a AHCCCS CARE account (similar to a Health Savings Account). 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, and specialized plans that include acute and behavioral health services for adults with serious mental illness and SUD.
  • Proposed amendment would impose work requirements on "able-bodied" expansion adults age 19-54, with disenrollment and lockout for failure to comply. Re-enrollment contingent upon proof of compliance for the previous 30 days.
  • Proposed amendment would impose five-year lifetime limit on benefits for all adults subject to work requirements. Only months for non-compliance with work requirements would count towards lifetime limit.
  • Proposed amendment would allow the state to redetermine eligibility for expansion adults every six months rather than annually, and after three months for individuals who fail to comply with work requirements.
  • Proposed amendment would eliminate retroactive coverage.
  • Proposed amendment would exempt "medically frail" individuals from work requirements and five-year lifetime limit. The state plans to develop a definition of "medically frail" that specifically includes people living with HIV.
  • Proposed amendment would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • Federal Application (April 2018)
  • Federal Application (December 2017)
  • 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's 1115 Waiver (December 2015)

California

Approved

Medi-Cal 2020 Demonstration

  • Status: Approved
  • 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
  • National Organization Comments on California's 1115 Waiver (October 2011)

Colorado

No Waiver

Connecticut

No Waiver

District of Columbia

No Waiver

Delaware

Pending

Diamond State Health Plan

  • Status: Renewal and Amendment Pending
  • Eliminates retroactive eligibility for most populations.
  • Expands community-based behavioral health services.
  • Proposed renewal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • Federal Application (June 2018)
  • Federal Application (June 2018)

Florida

Pending

Florida Managed Medical Assistance Program 

Georgia

No Waiver

Hawaii

Pending

Hawaii QUEST Integration

  • Status: Renewal and Amendment Pending
  • Expands community-based behavioral health benefits, including supportive housing services and SUD treatment.
  • Proposed amendment would provide supportive housing 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.
  • State Resources
  • Federal Approval
  • Federal Application (September 2018)
  • Federal Application (August 2017)

Iowa

Approved

Iowa Wellness Plan

Idaho

No Waiver

Illinois

Approved

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)

Indiana

Approved

Healthy Indiana Plan (HIP) 2.0

  • Status: Approved
  • Imposes 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. Enrollees may reactivate coverage by demonstrating compliance with work requirements for one month. Enrollees who fail to demonstrate compliance during the suspension period will be disenrolled at redetermination, and may reapply with no lockout period.
  • Establishes premiums through monthly contributions to a Personal Wellness and Responsibility (POWER) account (similar to a Health Savings Account). Disenrollment with six-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.
  • Waives 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 three-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 NEMT waiver.
  • State Resources
  • Federal Approval
  • National Organization Comments on Indiana’s Request to Amend 1115 Waiver Extension Request (July 2017)
  • 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: Renewal 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.
  • Proposed renewal would impose work requirements on "able-bodied adults" in all Medicaid eligibility categories, with disenrollment for failure to comply.
  • Proposed renewal would exempt people living with HIV from work requirement.
  • Proposed renewal would provide for optional state-funded "Independence Accounts" for Transitional Medical Assistance enrollees. Members who maintain employment for 12 months may access funds. Members who choose this option will be locked out of future coverage for a period of time to be determined by the state.
  • Proposed renewal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed renewal would exempt people living with HIV from work requirement.
  • REJECTED: Proposed renewal would have imposed a 36-month lifetime coverage limit for individuals who are subject to work requirements.
  • State Resources
  • Federal Approval
  • CMS Administrator Letter Rejecting Lifetime Limits (May 2018)
  • Federal Application (December 2017)
  • National Organization Comments on Kansas 1115 Waiver Extension Request (January 2018)

Kentucky

Pending

Kentucky HEALTH

  • Status: Amendment Pending
  • Waives non-emergency medical transportation for expansion population.
  • Waives non-emergency medical transportation for methadone for all beneficiaries except children subject to EPSDT, former foster youth, and pregnant women.
  • Eliminates retroactive coverage.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed amendment would impose premiums on sliding scale for families between 0 and 138% FPL, and waive household caps on premiums and cost-sharing by imposing minimum premium of $1 per month.
  • Proposed amendment would allow for waiting periods.
  • Proposed amendment would allow disenrollment with six-month lockout for failing to complete annual redetermination on time, missing premium payments (100% FPL only), misreporting work hours, and failing to report changes in circumstances. Early re-enrollment permitted upon payment of past due premiums and completion of early re-enrollment educational course.
  • Proposed amendment would require individuals at or below 100% FPL who miss premiums to pay copayments for all services, and their My Rewards Account will be suspended for six months. Beneficiaries who pay past due premiums and complete early re-enrollment educational course may have their account reinstated and will no longer be required to pay copayments.
  • Proposed amendment would provide beneficiaries with a My Rewards Account (similar to a Health Savings Account) to purchase extra benefits, such as vision and dental services, with healthy behavior and employment incentives to increase account balance. Account funds will be reduced for missed premium payments, non-emergency use of the ER, and missed appointments.
  • Proposed amendment would provide beneficiaries with state-funded $1,000 deductible account to cover plan deductible, with monthly statements detailing the costs of utilized services and remaining account balance. Enrollees who exhaust deductible account can still access covered services. Fifty percent of unused deductible funds maybe transferred to My Rewards Account.
  • Proposed amendment would impose work requirements as a condition of eligibility for most adults ages 19-64 in the Medicaid expansion, low-income parents and caretakers, and Transitional Medical Assistance (TMA) eligibility groups, with suspension and lockout for failure to comply. Re-enrollment contingent upon proof of compliance for the previous 30 days, or completion of re-enrollment health literacy or financial literacy course.
  • People living with HIV and hepatitis are considered medically frail. Medically frail are exempt from various provisions in the proposed amendment: work requirements, premiums and cost-sharing, lockouts, disenrollment for failure to report change in circumstances or complete redetermination on time, waiting period, and NEMT waiver.
  • State Resources
  • Federal Approval
  • Federal Application (August 2016, resubmitted July 2018)
  • National Organization Comments on Kentucky 1115 Waiver Application Amendments (August 2017)
  • NHeLP Comments on Kentucky 1115 Waiver Amendments (August 2017)
  • NHeLP Comments on Kentucky 1115 Waiver (October 2016)
  • National Organization Comments on Kentucky 1115 Waiver (October 2016)
  • AAHIVM Comments on Kentucky 1115 Waiver (July 2016)

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 wrap around) 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 waive 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 (five percent of aggregate household income) on an annual basis rather than a quarterly or monthly basis.
  • REJECTED: Proposed amendment would have imposed 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)
  • NHeLP Comments on Massachusetts 1115 Waiver Amendments (September 2017)

Maryland

Pending

Maryland Health Choice

  • Status: Amendment Pending
  • Enacts payment and delivery reform to address substance use disorders, including evidence-based benefit design, requiring providers to meet industry standards of care, implementing a comprehensive care coordination and management strategy, and reporting specific quality measures.
  • 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, including supportive housing services.
  • Proposed amendment seeks to expand services provided in IMDs to include medically managed intensive inpatient services, and to cover services in private IMDs for participants with a primary SUD diagnosis and secondary mental health diagnosis.
  • State Resources
  • Federal Approval
  • Federal Application (July 2018)

Maine

Pending

Maine Medicaid Health Care Reform Demonstration for People Living with HIV/AIDS

  • Status: Renewal Pending
  • Provides coverage for PLWH with incomes at or below 100% FPL who are otherwise eligible for Medicaid, and PLWH with incomes at or below 250% FPL who are not otherwise eligible for Medicaid.
  • State Resources
  • Federal Application (updated, May 2018)
  • Federal Application (May 2018)

MaineCare

  • Status: Pending
  • Proposal would limit "working-age, able-bodied" adults ages 19-64 to three months of coverage, after which beneficiaries must meet community engagement and work requirements as a condition of eligibility.
  • Proposal would require "able-bodied" adults ages 19-64 with incomes above 50% FPL to pay premiums, with disenrollment and three-month lockout for failure to comply. Early re-enrollment permitted upon payment of past due premiums.
  • Proposal would impose copayments for non-emergency use of the ER in excess of federal limit.
  • Proposal would apply an asset test to MAGI groups.
  • Proposal would eliminate retroactive eligibility.
  • Proposal would eliminate the option for qualified hospitals to make presumptive eligibility determinations.
  • Proposal would exempt people living with HIV who are enrolled in the state's HIV/AIDS waiver from premiums.
  • Proposal would exempt individuals who are "physically or mentally unable to work 20 or more hours per week" from work requirements and premiums.
  • State Resources
  • Federal Application (August 2017)
  • National Organization Comments on Maine 1115 Waiver (September 2017)
  • NHeLP Comments on Maine 1115 Waiver (September 2017)

Michigan

Pending

Healthy Michigan

  • Status: Renewal Pending
  • Requires compliance with "healthy behaviors" as a condition of eligibility for individuals with income over 100% FPL. Individuals who do not complete healthy behaviors within 12 months of enrollment will transition to Marketplace Option" (premium assistance model with Medicaid wraparound), and may re-enroll in Healthy Michigan upon completion of healthy behaviors.
  • Imposes monthly premiums on enrollees with incomes between 100 and 133% FPL in the form of contributions to MI Health Account (similar to a health savings account), with reduced premiums upon completion of "healthy behaviors." Failure to pay premiums can result in penalties such as loss of healthy behavior rewards or a reduced state tax return.
  • Imposes targeted cost-sharing for all enrollees in the Healthy Michigan Plan, with reduced copayments upon completion of "healthy behaviors."
  • 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.
  • Proposed amendment would impose work requirements for "able-bodied" adults age 19-62, with disenrollment and lockout for failure to comply for more than 3 months in a 12-month period. Re-enrollment contingent upon proof of compliance.
  • Proposed amendment would allow for disenrollment of individuals with incomes between 100 and 133% FPL who fail to comply with "healthy behaviors"; premiums, and cost-sharing requirements. Disenrollment would occur after 48 months of cumulative enrollment, with lockout until beneficiary comes into compliance.
  • Proposed amendment would require individuals with incomes between 100 and 133% FPL who have had 48 months of cumulative enrollment to engage in "healthy behaviors"; and pay premiums equal to 5% of their income in order to maintain eligibility. Premiums may not be reduced upon completion of healthy behaviors.
  • Proposed amendment would eliminate Marketplace Option.
  • Proposed renewal would exempt people living with HIV from work requirement, as well as from 48-month cumulative enrollment loss of coverage and 5% premium provisions.
  • Proposed renewal would waive copays for services related to treatment of viral hepatitis or HIV.
  • State Resources
  • Federal Approval
  • Federal Application (September 2018)
  • Federal Application (December 2017)
  • National Organization Comments on Michigan 1115 Waiver (October 2015)
  • National Organization Comments on Michigan 1115 Waiver (December 2013)

Michigan Pathway to Integration

  • Status: Pending
  • Proposal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposal would expand community-based behavioral health and SUD benefits.
  • Proposal would consolidate the state’s existing behavioral health 1915(b) and (c) waivers under section 1115 authority.
  • State Resources
  • Federal Application (July 2016)
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Minnesota

Both

Minnesota Pre-Paid Medical Assistance Project Plus

  • Status: Approved
  • Minnesota has a longstanding 1115 waiver that provides Medicaid coverage to otherwise uninsured populations in the state. The current demonstration project provides coverage to children and adults who have higher incomes than federal income thresholds for the program.
  • This demonstration served as a bridge to the "Basic Health Plan." The demonstration project is no longer necessary to continue the Minnesota Care program, which transitioned from Medicaid to Basic Health Plan authority in 2015, but is still needed to operate some aspects of Minnesota's Medicaid program.
  • State Resources
  • Federal Approval

Minnesota Substance Use Disorder System Reform

  • 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 2018)

Missouri

Pending

Missouri Gateway to Better Health

  • Status: Amendment Pending
  • Proposed amendment would add SUD treatment to the benefit package, authorizing the state to cover office visits and generic prescriptions for substance use treatment.
  • Proposal seeks to clarify 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 Application (August 2018)

Mississippi

Pending

Mississippi Medicaid Workforce Training Initiative

  • Status: Pending
  • Proposal would impose work requirements on "able-bodied" adults currently covered under traditional Medicaid, including low-income parents and caretakers and individuals eligible for Transitional Medical Assistance (TMA). Individuals who fail to meet work requirements will be disenrolled with lockout until compliance is achieved.
  • Proposal would provide additional 12 months of coverage for TMA enrollees who comply with work requirements.
  • Proposal would exempt enrollees who are "physically or mentally unable to work" from work requirements.
  • State Resources
  • Federal Application (January 2018 and May 2018)
  • National Organization Comments on Mississippi 1115 Waiver (February 2018)

Montana

Approved

Montana Health and Economic Livelihood Partnership (HELP)

  • Status: Approved
  • Authorizes 12 months of continuous coverage for the Medicaid expansion population.
  • Imposes premium requirement 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.
  • State Resources
  • Federal Approval
  • National Organization Comments on Montana HELP Program 1115 Waiver (October 2015)

North Carolina

Pending

North Carolina's Medicaid Reform Demonstration

  • Status: Pending
  • Proposal would impose work requirements as a condition of eligibility for most Medicaid expansion adults (legislation to adopt Medicaid expansion in the state is still pending).
  • Proposal would impose premiums on Medicaid expansion adults with incomes above 50% FPL, with disenrollment and lockout for failure to pay. Re-enrollment is contingent upon payment of past due premiums.
  • Proposal would integrate behavioral health services with primary care.
  • Proposal would create special needs health plans targeted to people with serious mental illness or substance use disorder.
  • Proposal includes funding for pilot programs to test evidence-based interventions in four domains of social determinants of health: housing, food, transportation, and interpersonal safety/toxic stress.
  • Proposal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposal would connect Medicaid provider data tothe state HIE.
  • State Resources
  • Federal Application (November 2017)
  • National Organization Comments on North Carolina 1115 Waiver Amendments (January 2018)
  • Duke Health Justice Clinic and North Carolina AIDS Action Network (NCAAN) Comments on North Carolina 1115 Waiver (April 2016)

North Dakota

No Waiver

Nebraska

No Waiver

New Hampshire

Both

New Hampshire Health Protection Program

  • Status: Renewal Pending
  • New Hampshire Health Protection Program will sunset on December 31, 2018. Proposed renewal would create the Granite Advantage Health Care Program to provide coverage to the Medicaid expansion population for the next five years.
  • Imposes work requirements as a condition of eligibility for "able-bodied" expansion adults, with lockout until next redetermination for failure to comply. Enrollees may reactivate coverage by demonstrating compliance with work requirements for one month. Enrollees who fail to demonstrate compliance during the suspension period will be disenrolled at redetermination, and may reapply with no lockout period.
  • Uses premium assistance to purchase Qualified Health Plans (QHPs) through the Marketplace for the Medicaid expansion population (non-disabled adults with income up to 138% FPL).
  • 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 retroactive coverage.
  • Proposed renewal would transition individuals currently receiving QHP premium assistance to the state's managed care delivery system.
  • Proposed renewal would create new health behavior and cost effectiveness provisions in the state's manager care program.
  • Proposed renewal would make eligibility contingent upon applicants verifying US citizenship with two forms of paper identification, and verifying New Hampshire residency with either a New Hampshire driver's license or a non-driver's picture identification card.
  • Proposed renewal would apply an asset test to consider applicant assets in determining eligibility such that individuals with countable assets in excess of $25,000 would not be eligible.
  • Proposed renewal would require enrollees to report changes in financial eligibility, residency, citizenship, immigration status, or insurance coverage within 10 days of such change.
  • Proposed renewal would restore 24-hour prior authorization requirement for prescription drugs for all enrollees.
  • State Resources
  • Federal Approval
  • Federal Application (July 2018)
  • National Organization Comments on New Hampshire 1115 Waiver Amendments (December 2017)
  • NHeLP Comments on New Hampshire 1115 Waiver Amendments (December 2017)
  • Center on Budget and Policy Priorities and Georgetown University Center for Children and Families Comments on New Hampshire 1115 Waiver (September 2016)

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 Jersey

Pending

New Jersey Family Care Comprehensive Demonstration

New Mexico

Pending

Centennial Care

  • Status: Renewal Pending
  • Access to expanded benefits for individuals who complete "healthy behaviors."
  • Proposed renewal would impose premiums on adult expansion groupenrollees above 100% FPL, with disenrollment and 90-day lockout for failure to pay. Re-enrollment is contingent upon payment of past due premiums. Rewards earned through completion of "healthy behaviors" can be applied to premiums.
  • Proposed renewal would impose copayments for non-preferred prescription drugs and non-emergency use of the ER in excess of federal limit.
  • Proposed renewal would impose missed appointment fee for enrollees who miss three scheduled appointments in a calendar year without notifying to the provider.
  • Proposed renewal would eliminate retroactive coverage.
  • Proposed renewal would eliminate Transitional Medical Assistance for parents/caretakers.
  • Proposed renewal would waive requirement to provide EPSDT to 19- and 20-year olds in Medicaid expansion population.
  • Proposed renewal would waive requirement to cap premiums and cost-sharing amounts at five percent of household income.
  • Proposed renewal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • Federal Application (December 2017)
  • National Organization Comments on New Mexico 1115 Waiver (January 2018)

Nevada

No Waiver

New York

Approved

New York Medicaid Redesign Team

Ohio

Pending

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

  • Status: Pending
  • Proposal would impose work requirements as a condition of eligibility for expansion adults ages 19-49, with disenrollment for failure to comply.
  • Proposal would exempt 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.
  • Proposal would exempt enrollees who are "physically or mentally unfit for employment" from work requirements.
  • Federal Application (April 2018)
  • National Organization Comments on Ohio 1115 Waiver (June 2018)

Oklahoma

Approved

Oklahoma SoonerCare

  • Status: Approved
  • 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.
  • State Resources
  • Federal Approval

Oregon

No Waiver

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

No Waiver

South Carolina

No Waiver

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.
  • Proposal would implement premium assistance model for purchase of Qualified Health Plans for one additional year of Transitional Medical Assistance (TMA) coverage after expiration of original TMA period.
  • State Resources
  • Federal Application (August 2018)

Tennessee

Pending

TennCare II

Texas

No Waiver

Utah

Pending

Utah Primary Care Network

  • Status: Amendments Pending
  • Provides limited coverage of preventive and primary care for uninsured adults up to 95% FPL. Enrollment cap of 25,000.
  • Provides reduced Medicaid benefits package for parent and caretakerrelatives with incomes below 40% FPL.
  • 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. State may elect to impose enrollment cap.
  • Eliminates retroactive coverage for certain enrollees.
  • Waives requirement to provide EPSDT 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.
  • Proposed amendment would impose five-year lifetime cap on benefits for certain adults with incomes under 95% FPL.
  • Proposed amendment seeks partial expansion to 95% FPL, with a cap on enrollment.
  • Proposed amendment would impose work requirement as a condition of eligibility for "able-bodied" adults ages 19-64, with disenrollment and lockout for failure to comply. Re-enrollment contingent upon proof of compliance.
  • Proposed amendment would eliminate presumptive eligibility.
  • Proposed amendment would expand dental services to certain adults with income at 0% FPL who are receiving SUD treatment.
  • Proposal would exempt enrollees who are "physically or mentally unable to work" from work requirements.
  • State Resources
  • Federal Approval
  • Federal Application (June 29, 2018)
  • Federal Application (June 22, 2018)
  • Federal Application (August 2017)
  • National Organization Comments on Utah 1115 Waiver Extension Amendments (September 2017)
  • NHeLP Comments on Utal 1115 Waiver Extension Amendments (September 2017)

Virginia

Approved

The Virginia Governor's Access Plan (GAP) and Addiction and Recovery Treatment Services (ARTS) Delivery System Transformation

  • Status: Approved
  • Expands SUD services to populations not otherwise eligible for Medicaid.
  • Provides medical and behavioral health care coverage for low-income individuals with serious mental illness.
  • Adds coverage for peer support services under the state plan to support long term recovery.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources - ARTS
  • State Resources - GAP
  • Federal Approval

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.
  • Expands community-based behavioral health benefits.
  • State Resources
  • Federal Approval

Washington

Approved

Washington Medicaid Transformation Project

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

Wisconsin

Pending

Wisconsin BadgerCare Reform 

  • Status: Renewal Pending
  • Provides benefits to non-pregnant, non-disabled childless adults with incomes up to 100% FPL.
  • Imposes premiums for parents/caretakers with incomes above 100% FPL who qualify for only Medicaid Transitional Medical Assistance (TMA), with disenrollment and three-month lockout for failure to comply. The three-month lockout period counts towards the 12-month TMA extension period. Early re-enrollment permitted upon payment of past due premiums.
  • Expands coverage to former foster care youth under age 26 from different states.
  • Proposed renewal would impose premiums for individuals with incomes above 50% FPL, with disenrollment and six-month lockout for failure to comply. Early re-enrollment permitted upon payment of past due premiums.
  • Proposed renewal would reduce premiums for individuals who complete a health risk assessment and who do not engage in "health risk behaviors," including alcohol consumption and illicit drug use.
  • Proposed renewal would impose work requirements as a condition of eligibility for childless adults ages 19-49.
  • Proposed renewal would impose 48-month enrollment time limit, followed by six-month lockout. Months in which the individual meets work requirements would not count towards the 48-month limit.
  • Proposed renewal would impose drug testing requirements as a condition of eligibility. Adults without dependent children must complete a drug screening questionnaire as a condition of eligibility, and those whose answers indicate possible abuse of a controlled substance must undergo drug testing and/or treatment program to receive coverage.
  • Proposed renewal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed renewal would exempt enrollees who are “physically or mentally unable to work” from work requirements and 48-month enrollment time limit.
  • State Resources
  • Federal Approval
  • Federal Application (January 2018)
  • Federal Application (June 2017)
  • National Organization Comments on Wisconsin 1115 Waiver Amendments (February 2018)
  • NHeLP Comments on Wisconsin 1115 Waiver Amendments (July 2017)
  • National Organization Comments on Wisconsin 1115 Waiver Amendments (July 2017)

Wisconsin Senior Care

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.
  • Expands community-based behavioral health benefits.
  • Federal Approval

Wyoming

Pending

Wyoming Medicaid Tribal Uncompensated Care Section 1115 Demonstration

  • Status: Pending
  • Proposal would provide supplemental payments to qualifying tribal health facilities.
  • Federal Application (January 2016)

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?