Examples of Section 1115 Waivers
Indiana's HIP 2.0 waiver allows enrollees, who contribute to
a health savings account (HSA), access to benefits not
otherwise available, including dental and vision. It also
waives the requirement for non-emergent medical
transportation.
West Virginia, in response to the opioid crisis, submitted a
waiver that aims to improve prevention and treatment for
Medicaid enrollees with substance use disorders.
Massachusetts is using its waiver to implement a statewide
Medicaid accountable care organization (ACO) delivery
system to improve care integration (including behavioral
health and long-term services and supports), to support
safety net care redesign, and to expand substance use
disorders (SUD) programs to combat the opioid crisis.
Goal
Trinity Health is committed to public policies that support better health, better care and lower costs to ensure
affordable, high-quality, people-centered care for all. As Trinity Health assesses key components of Affordable Care Act
(ACA) replacement proposals, it is important to review the pros and cons associated with each proposal and to evaluate
the impact on coverage and access to affordable, high-quality, people-centered care.
Background & Purpose
Section 1115 of the Social Security Act (SSA) allows the
Secretary of Health and Human Services (HHS) to waive most
federal Medicaid requirements and authorize “any
experimental, pilot or demonstration project likely to assist in
promoting the objectives” of the Medicaid program. States
have used this broad authority to obtain flexibilities in a wide
variety of ways. States have been permitted to waive
requirements that programs be statewide, or that programs or
services be available to all eligible beneficiaries, and to
implement delivery and payment reforms. Additionally, states
may design waivers to implement structural or financing
reform (e.g. block grants or per capita caps), or to supplement
federal reforms. The table below provides the “pros” and
“cons” of using Section 1115 waivers, based on available
research and evidence assessing their impact and success.
Policy
Pro
1
Con
2
Use Section
1115 Waivers
to Pilot State
Innovations
that Improve
Care, Health,
and Control
Costs
Allow states significant flexibilities, permitting
innovation within the Medicaid program.
Allows testing of delivery reforms that may
reduce costs, improve care and increase
efficiencies.
Pilot demonstrations for populations with
unique needs (e.g. individuals with SUD).
Budget neutrality requirement allows for
innovation without negative budget impact.
May be used to limit enrollment or access to
care (e.g. work requirements, enrollment caps,
benefits changes, or increased cost-sharing).
Approved waivers reflect Administration policy
goals and shift with political priorities.
Historically, waiver design and approval has
lacked transparency and been a lengthy/
cumbersome process, impeding timely
implementation of demonstrations.
Overall Takeaway – Section 1115 waivers are a proven tool through which states can test innovations within their
Medicaid programs that improve access and quality of care, control costs and reflect their state’s needs.
Trinity Health Supports use of section of 1115 waivers to promote reforms and innovations that improve access to
care and population health and to lower health care costs.
Supporting Research: 1. CRS Medicaid: An Overview. CMS, About Section 1115 Demonstrations, Medicaid and CHIP Payment and Access Commission (MACPAC), Waivers.
Accessed November 16, 2015. 2. GAO, Medicaid Demonstration: More Transparency and Accountability for Approved Spending Are Needed GAO-15-715T, June 24, 2015.
http://advocacy.trinity-health.org [email protected]
Mission: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate
and transforming healing presence within our communities.
Core Values: Reverence • Commitment to Those Who Are Poor • Justice • Stewardship • Integrity
Medicaid Section 1115 Waivers:
Policy Goals and Evidence
