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. Click on any highlighted state to learn more. (Last Updated: July 6, 2017)

Alabama

Family Planning 1115 Waiver

Plan First (Family Planning 1115 Waiver)

Alaska

Not Applicable

No Pending 1115 Waiver

American Samoa

Not Applicable

No Pending 1115 Waiver

Arizona

Medicaid Transformation 1115 Waiver

Arizona 1115 Waiver (Medicaid Transformation 1115 Waiver)

Arkansas

Medicaid Expansion 1115 Waiver

Arkansas Works (Medicaid Expansion 1115 Waiver)

California

Medicaid Transformation 1115 Waiver

Medi-Cal 2020 Demonstration (Medicaid Transformation 1115 Waiver)

  • 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
  • Recent amendment to the waiver includes "health home" initiative, which 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
  • State Resources
  • Federal Approval
  • National Organization Comments on California's 1115 Waiver

Colorado

Not Applicable

No Pending 1115 Waiver

Connecticut

Not Applicable

No Pending 1115 Waiver

Delaware

Medicaid Transformation 1115 Waiver

Diamond State Health Plan (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • Expands mandatory managed care delivery system to most Medicaid beneficiaries in the state
  • Offers expanded behavioral health services for enrollees with behavioral health needs
  • Imposes nominal cost sharing requirements on beneficiaries
  • State Resources
  • Federal Approval

Federated States of Micronesia

Not Applicable

No Pending 1115 Waiver

Florida

Family Planning and Medicaid Transformation 1115 Waivers

Florida Medicaid Family Planning Waiver (Family Planning 1115 Waiver)

  • Status: Approved
  • Provides family planning services (including STI testing) to women of childbearing age losing Medicaid pregnancy coverage or full Medicaid coverage, who have family income at or below 185% FPL
  • State Resources
  • Federal Approval

Florida Managed Medical Assistance Program (Medicaid Transformation 1115 Waiver)

Georgia

Family Planning 1115 Waiver

Georgia Planning for Healthy Babies (Family Planning 1115 Waiver)

  • Status: Pending Renewal
  • Provides family planning and family planning related services (including STI testing) to women, aged 18-44, with a family income at or below 200% FPL, who are not otherwise eligible for Medicaid or CHIP
  • State Resources
  • Federal Approval

Guam

Not Applicable

No Pending 1115 Waiver

Hawaii

Medicaid Transformation 1115 Waiver

Hawaii QUEST Integration (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • Allows the state to operate its Medicaid program through a mandatory managed care delivery system for most beneficiaries, with enhanced benefits for beneficiaries with specific needs
  • State Resources
  • Federal Approval

Idaho

Not Applicable

No Pending 1115 Waiver

Illinois

Medicaid Transformation 1115 Waiver

Illinois Behavioral Health Transformation Waiver (Medicaid Transformation 1115 Waiver)

Indiana

Medicaid Expansion 1115 Waiver

Healthy Indiana Plan (HIP) 2.0 (Medicaid Expansion 1115 Waiver)

Iowa

Family Planning and Medicaid Expansion 1115 Waivers

Iowa Health and Wellness Plan (Medicaid Expansion 1115 Waiver)

Iowa Family Planning Network (Family Planning 1115 Waiver)

  • Status: Approved
  • Provides family planning services to the following individuals not otherwise enrolled in Medicaid with income up to 300% FPL: women losing pregnancy coverage at the conclusion of the 60-day post-partum coverage period; women under the age of 55 capable of bearing children; and men under the age of 55 capable of fathering children
  • State Resources
  • Federal Approval

Kansas

Medicaid Transformation 1115 Waiver

KanCare (Medicaid Transformation 1115 Waiver)

Kentucky

Medicaid Expansion 1115 Waiver

Kentucky HEALTH (Medicaid Expansion 1115 Waiver)

  • Status: Extension and Amendment Pending
  • Change Medicaid expansion by imposing premiums on sliding scale for individuals between 0-138% FPL
  • Allows people above 100% FPL to be dis-enrolled for failure to pay premium
  • Requires up to 20 hours of employment activities as condition of eligibility for most adults
  • Waives non-emergency medical transportation for expansion population
  • Adds health savings accounts and provides incentives to use account to purchase extra benefits
  • Amends benefits package for expansion population to align with state employee plan.
  • State Resources
  • Federal Application
  • AAHIVM Comments on Kentucky 1115 Waiver
  • National Organization Comments on Kentucky 1115 Waiver

Louisiana

Not Applicable

No Pending 1115 Waiver

Maine

Medicaid Transformation 1115 Waiver

Maine Medicaid Health Care Reform Demonstration for People Living with HIV/AIDS (Medicaid Transformation 1115 Waiver)

  • Status: Extension and Amendment Pending
  • Extends longstanding waiver expanding eligibility to individuals living with HIV with income at or below 100% FPL
  • State Resources
  • Federal Application

Marshall Islands

Not Applicable

No Pending 1115 Waiver

Maryland

Medicaid Transformation 1115 Waiver

Maryland Health Choice (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • 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
  • State Resources
  • Federal Approval

Massachusetts

Medicaid Transformation 1115 Waiver

MassHealth (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • 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
  • Waiver maintains longstanding program for people living with HIV
  • State Resources
  • Federal Approval
  • National Organization Comments on Massachusetts 1115 Waiver

Michigan

Medicaid Expansion 1115 Waiver

Healthy Michigan (Medicaid Expansion 1115 Waiver)

Minnesota

Medicaid Transformation 1115 Waiver

Minnesota Pre-Paid Medical Assistance Program Plus (Medicaid Transformation 1115 Waiver)

  • 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
  • Expands the demonstration project eligibility to MinnesotaCare Adults without Children, ages 21 through 64, with income above 75% FPL and below 250% FPL. This population and allows the demonstration project to serve as a bridge to the "Basic Health Plan" in Minnesota
  • State Resources
  • Federal Approval

Mississippi

Family Planning and Medicaid Transformation 1115 Waivers

Mississippi Family Planning Waiver (Family Planning 1115 Waiver)

  • Status: Extension Pending
  • Provides family planning and family planning-related services to women losing Medicaid pregnancy coverage at the expiration of the 60-day postpartum period and to women and men, aged 13-44, who have family incomes at or below 194% FPL who are not otherwise eligible for Medicaid
  • State Resources
  • Federal Approval

Healthier Mississippi (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • Provides limited benefits to aged and disabled population up to 135% FPL who are not otherwise eligible for Medicare or Medicaid
  • State Resources
  • Federal Approval

Missouri

Medicaid Transformation 1115 Waiver

Mental Health Crisis Prevention Demonstration Project (Medicaid Transformation 1115 Waiver)

Missouri Gateway to Better Health (Medicaid Transformation 1115 Waiver)

  • Status: Extension pending
  • Provided coverage through a limited provider network of five safety net providers for uninsured individuals, age 19 through 64, who reside in the St. Louis region with incomes at or below 100% FPL
  • State Resources
  • Federal Application

Montana

Medicaid Expansion and Medicaid Transformation 1115 Waivers

Montana Health and Economic Livelihood Partnership (HELP) (Medicaid Expansion 1115 Waiver)

Montana Waiver for Additional Services and Populations (Medicaid Transformation 1115 Waiver)

  • Status: Extension Pending
  • Continues to cover individuals with severe disabling mental illnesses enrolled in the state financed mental health services plan and provides dental coverage for the aged, blind, and disabled population
  • Provides 12-month continuous eligibility for the non-Medicaid expansion population
  • State Resources
  • Federal Application

Nebraska

Not Applicable

No Pending 1115 Waiver

Nevada

Medicaid Transformation 1115 Waiver

Nevada Comprehensive Care Waiver (Medicaid Transformation 11115 Waiver)

  • Status: Approved
  • Uses Care Management Organizations to provide additional care coordination services in Medicaid managed care for designated high needs populations (including people living with HIV)
  • State Resources
  • Federal Approval

New Hampshire

Medicaid Expansion and Medicaid Transformation 1115 Waivers

New Hampshire Health Protection Program Premium Assistance (Medicaid Expansion 1115 Waiver)

New Hampshire Building Capacity for Transformation (Medicaid Transformation 1115 Waiver)

  • 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 Jersey

Medicaid Transformation 1115 Waiver

New Jersey Comprehensive Waiver (Medicaid Transformation 1115 Waiver)

  • Status: Amendment Application Pending
  • Expands Medicaid managed care to include long-term care services and supports
  • Provides home and community-based services to Medicaid beneficiaries with serious emotional disturbance, opioid addiction, autism spectrum disorder, or intellectual disabilities/developmental disabilities
  • Enacts DSRIP program to incentivize population health initiatives
  • State Resources
  • Federal Approval

New Mexico

Medicaid Transformation 1115 Waiver

Centennial Care (Medicaid Transformation 1115 Waiver)

New York

Medicaid Transformation 1115 Waiver

New York Medicaid Redesign Team (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • Managed care delivery system for Medicaid recipients
  • Home and Community Based Services (HCBS) Expansion program provides cost-effective home and community based services to certain adults with significant medical needs as an alternative to institutional care
  • DSRIP program provides incentive funds for providers
  • Health and Recovery Plans (HARPs) integrate physical and behavioral health and HCBS for Medicaid enrollees with severe mental illness and/or substance use disorder to receive services in their own homes and communities
  • Capitated Special Needs Plans serve PLWH who require intensive case-managed care regimens
  • State Resources
  • Federal Approval

North Carolina

Medicaid Transformation 1115 Waiver

North Carolina's Medicaid Reform Demonstration (Medicaid Transformation 1115 Waiver)

  • Status: Pending
  • Managed care model using pre-paid health plans with contracts for value-based payments based on health and cost outcomes
  • Integration of behavioral health services with primary care
  • Creation of "person-centered health communities" to address social determinants of health
  • Expands access to safety net services in rural areas (including FQHCs and rural health centers)
  • Medicaid provider data will be connected to the state HIE
  • Health workforce initiatives: community-based residency programs and health workforce education in underserved areas for preventive health and ambulatory care
  • Uncompensated care payments to public and private safety net hospitals
  • DSRIP initiatives for public hospitals, private hospitals, local health departments, and academic medical centers with performance- and outcome-based incentive payments
  • State Resources
  • Federal Application
  • Duke Health Justice Clinic and North Carolina AIDS Action Network (NCAAN) Comments on North Carolina's 1115 Waiver

North Dakota

Not Applicable

No Pending 1115 Waiver

Northern Mariana Islands

Not Applicable

No Pending 1115 Waiver

Ohio

Not Applicable

No Pending 1115 Waiver

Oklahoma

Medicaid Transformation 1115 Waiver

Oklahoma SoonerCare (Medicaid Transformation 1115 Waiver)

  • Status: Pending
  • Operates state Medicaid plan (SoonerCare) as a managed care delivery system
  • 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
  • State Resources
  • Federal Application

Oregon

Family Planning and Medicaid Transformation 1115 Waivers

Oregon Health Plan (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • Coordinated Care Organization (CCO) model for state plan
  • Care based on a prioritized list of health services
  • Eligibility: adults up to 138% FPL and children up to 18 years old with family income up to 300% FPL
  • Provides performance-based incentive payments to primary care providers and incentive payments to hospitals that adopt quality improvement initiatives
  • State Resources
  • Federal Approval

Oregon Contraceptive Care (Family Planning 1115 Waiver)

  • Status: Extension Approved
  • Covers family planning services for men and women of childbearing age who are otherwise not eligible for Medicaid or CHIP and whose household income is at or below 250% FPL
  • State Resources
  • Federal Approval

Palau

Not Applicable

No Pending 1115 Waiver

Puerto Rico

Not Applicable

No Pending 1115 Waiver

Rhode Island

Medicaid Transformation 1115 Waiver

Rhode Island Comprehensive Demonstration (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • Rite Care: Medicaid managed care program for families with children, pregnant women, and children under age 19 (up to 250% FPL)
  • Extended Family Planning provides access to family planning and referrals to primary care services for women below 200% FPL who lose Medicaid eligibility under RIte Care postpartum
  • RIte Share: premium assistance for individuals who are eligible for Medicaid and have access to a qualified employer-sponsored plan
  • Rhody Health Partners: Medicaid managed care for aged, blind, and disabled beneficiaries and for adults at or below 133% FPL
  • Rhody Health Options: managed care delivery system for Medicaid and dual-eligibles that integrates acute and primary care and long term care services and supports
  • Connect Care Choice: provides Medicaid state plan benefits to aged, blind, and disabled beneficiaries who have no other health insurance, through a primary care case management system
  • Connect Care Choice Community Partners: optional delivery system for Adult, Blind and Disabled Medicaid and dual-eligibles that utilizes a community health team and a Coordinating Care Entity to integrate Medicaid benefits
  • Funding for designated state health programs (DSHPs) that promote healthcare workforce development to ensure access to trained healthcare professionals for eligible individuals.
  • State Resources
  • Federal Approval

South Carolina

Not Applicable

No Pending 1115 Waiver

South Dakota

Not Applicable

No Pending 1115 Waiver

Tennessee

Medicaid Transformation 1115 Waiver

TennCare II (Medicaid Transformation 1115 Waiver)

Texas

Medicaid Transformation 1115 Waiver

Texas Healthcare Transformation and Quality Improvement Program (Medicaid Transformation 1115 Waiver)

Utah

Medicaid Transformation 1115 Waiver

Utah Primary Care Network (Medicaid Transformation 1115 Waiver)

Vermont

Medicaid Transformation 1115 Waiver

Vermont Global Commitment to Health (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • Establishes Office of Vermont Health Access as a public MCO
  • Establishes an all-payer Accountable Care Organization initiative (2017 extension)
  • Premium subsidies for individuals enrolled in a QHP with incomes at or below 300% FPL
  • Provides full Medicaid benefits to pregnant women who are determined presumptively eligible
  • State Resources
  • Federal Approval

Virgin Islands

Not Applicable

No Pending 1115 Waiver

Virginia

Family Planning and Medicaid Transformation 1115 Waivers

The Virginia Governor's Access Plan (GAP) and Addiction and Recovery Treatment Services (ARTS) Delivery System Transformation (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • GAP: Provides medical and behavioral health care coverage for low-income individuals with serious mental illness
  • ARTS: Expands substance use disorder benefits package to all Medicaid members, including short-term residential and inpatient services
  • ARTS: Adds coverage for peer support services under the state plan to support long term recovery
  • State Resources - ARTS
  • State Resources - GAP
  • Federal Approval

Virginia FAMIS MOMS and FAMIS Select (Family Planning 1115 Waiver)

Virginia Delivery Transformation 1115 Demonstration (Medicaid Transformation 1115 Waiver)

  • Status: Pending
  • Medicaid Managed Long Term Services and Supports (MMLTSS): Expands existing Commonwealth Coordinated Care (CCC) statewide and to additional populations (to include Medicaid/Medicare dual-eligible members; non-dual members who receive Medicaid LTSS; and members of Aged, Blind, and Disabled (ABD) Medicaid coverage groups); mandates enrollment of eligible individuals into competitively-selected managed care plans
  • Delivery System Reform Incentive Program (DSRIP): provides funding to support provider readiness for value-based payments; establishes groups of high performing providers known as Virginia Integration Partners (VIPs) to share and integrate care collaboration, data, processes, and communication
  • State Resources - MMLTSS
  • State Resources - DSRIP
  • Federal Application

Washington

Family Planning and Medicaid Transformation 1115 Waivers

Washington State Medicaid Transformation (Medicaid Transformation 1115 Waiver)

  • 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
  • ACHs receive funds only after they meet project goals (process milestones and improvements in outcome measures)
  • Supported services for housing (i.e., services to get and keep housing) and employment (e.g., job coaching/training, job placement assistance) through existing Medicaid delivery systems
  • State Resources
  • Federal Approval

Washington Take Charge (Family Planning 1115 Waiver)

  • Status: Approved
  • Provides family planning and family planning-related services to women losing Medicaid pregnancy coverage, and to women and men who have family incomes at or below 250% FPL who are not otherwise eligible for Medicaid or CHIP
  • State Resources
  • Federal Approval

Washington D.C.

Not Applicable

No Pending 1115 Waiver

West Virginia

Medicaid Transformation 1115 Waiver

West Virginia Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorder (Medicaid Transformation 1115 Waiver)

  • Status: Pending
  • Provide substance use disorder services to Medicaid beneficiaries through the fee-for-service delivery system
  • Federal Application

Wisconsin

Medicaid Expansion and Medicaid Transformation 1115 Waivers

Wisconsin BadgerCare (Medicaid Transformation 1115 Waiver)

Wisconsin BadgerCare Reform (Medicaid Expansion 1115 Waiver)

  • Status: Approved
  • Provides benefits to nonpregnant, non-disabled childless adults with incomes up to 100% FPL
  • Requires premiums to parents/caretakers with incomes above 100% FPL who qualify for only Medicaid Transitional Medical Assistance (TMA)
  • State Resources
  • Federal Approval

Wisconsin Senior Care (Medicaid Transformation 1115 Waiver)

  • Status: Approved
  • Provides comprehensive prescription drug benefits to Wisconsin residents over age 65 with income at or below 200% FPL
  • State Resources
  • Federal Approval

Wyoming

Family Planning and Medicaid Transformation 1115 Waivers

Wyoming Medicaid Tribal Uncompensated Care Section 1115 Demonstration (Medicaid Transformation 1115 Waiver)

WY Pregnant by Choice (Family Planning 1115 Waiver)

  • Status: Approved
  • Provides family planning and family planning-related services to women aged 19-44 with family incomes up to 159% FPL who lose Medicaid through the Wyoming Medicaid Pregnant Woman Program
  • State Resources
  • Federal Approval

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
  • Increase cost-sharing and premium requirements for Medicaid beneficiaries and/or impose work-related requirements as a condition of eligibility
  • Expand eligibility for family planning services, for instance, increasing the income threshold and expanding the program to men as well as women

How Do Medicaid 1115 Waivers Impact HIV 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 

What Other Resources Are There on 1115 Waivers?