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How do Section 1115 waivers contribute to state-level adaptability within the Medicaid program?
Table of Contents
- 1. How do Section 1115 waivers contribute to state-level adaptability within the Medicaid program?
- 2. Medicaid Section 1115 Waiver Status: Extensive Overview of Approved and pending Waivers by State
- 3. Understanding Section 1115 Waivers & Medicaid Expansion
- 4. Approved 1115 Waivers: A State-by-State Snapshot (as of September 23, 2025)
- 5. Pending 1115 Waiver Applications: States to Watch
- 6. Key Themes in Current Waiver Applications
Medicaid Section 1115 Waiver Status: Extensive Overview of Approved and pending Waivers by State
Understanding Section 1115 Waivers & Medicaid Expansion
Section 1115 waivers, authorized under the Social Security Act, allow states to test innovative approaches in Medicaid and Children’s Health Insurance Program (CHIP) that differ from statutory requirements. These “research and exhibition” projects aim to improve healthcare access, quality, and outcomes. They are a critical component of state flexibility within the Medicaid program, particularly in the context of Medicaid expansion and addressing specific state needs like healthcare access, behavioral health, and chronic disease management. Understanding the current status of these waivers is crucial for healthcare providers, policymakers, and beneficiaries alike.
Approved 1115 Waivers: A State-by-State Snapshot (as of September 23, 2025)
This section provides a concise overview of states with currently approved 1115 waivers.Note: Waiver details are subject to change.
* arizona: Focused on regional care networks and addressing behavioral health needs. key features include integrated care models and expansion of substance use disorder treatment.
* Arkansas: “Arkansas Works” waiver focuses on community engagement requirements for certain beneficiaries, aiming to promote employment and self-sufficiency. (Subject to ongoing legal challenges).
* California: “CalAIM” (California Advancing and Innovating medi-Cal) is a comprehensive waiver aiming to transform the state’s Medicaid program through population health management, addressing social determinants of health, and expanding covered services.
* colorado: Waiver focuses on behavioral health integration, including expanding access to substance use disorder treatment and mental health services.
* Indiana: “Healthy Indiana Plan” (HIP) waiver includes a focus on member responsibility and incentivizes preventative care.
* Kentucky: “kentucky HEALTH” waiver (currently under revisions) previously included work requirements and premium contributions.
* Massachusetts: Focuses on delivery system reform and payment innovation, aiming to improve care coordination and quality.
* Michigan: Waiver focuses on expanding Medicaid coverage for dental and vision services, as well as addressing behavioral health needs.
* Minnesota: Focuses on expanding access to behavioral health services and addressing health disparities.
* New Jersey: Waiver focuses on expanding Medicaid coverage for pregnant women and postpartum care.
* North Carolina: “Healthy Opportunities” waiver focuses on addressing social determinants of health by providing services like housing, food, and transportation.
* Oregon: Focuses on coordinated care organizations (CCOs) and value-based payment models.
* Pennsylvania: Waiver focuses on expanding Medicaid coverage for home and community-based services.
* Tennessee: “TennCare III” waiver focuses on managed care and delivery system reform.
* Texas: Focuses on uncompensated care payments and delivery system reform. (Historically contentious, with frequent legal challenges).
* Utah: Waiver focuses on expanding Medicaid coverage and implementing a managed care system.
* Washington: Focuses on behavioral health integration and addressing the opioid crisis.
Keywords: Medicaid waivers by state, approved waivers, state Medicaid programs, Medicaid expansion states, healthcare policy.
Pending 1115 Waiver Applications: States to Watch
Several states have pending 1115 waiver applications under review by the Centers for Medicare & Medicaid Services (CMS). These applications often represent significant shifts in state Medicaid policy.
* Florida: A proposal to import prescription drugs from Canada to lower costs. (Facing significant federal hurdles).
* Louisiana: Focuses on expanding managed care and addressing chronic disease management.
* Missouri: Aims to implement work requirements and other eligibility restrictions. (Likely to face CMS scrutiny).
* South Carolina: Focuses on expanding Medicaid coverage and implementing a managed care system.
* Wisconsin: Focuses on expanding access to behavioral health services and addressing the opioid crisis.
Keywords: pending Medicaid waivers, Medicaid waiver applications, CMS waiver approvals, Medicaid policy changes, state healthcare initiatives.
Key Themes in Current Waiver Applications
Several overarching themes are emerging in the latest round of 1115 waiver applications:
- Addressing Social Determinants of Health (SDOH): States are increasingly seeking waivers to fund services that address non-medical factors impacting health, such as housing, food security, and transportation.North Carolina’s “Healthy Opportunities” waiver is a prime example.
- Behavioral Health Integration: A significant number of waivers focus on expanding access to mental health and substance use disorder treatment,frequently enough through integrated care models.
- Value-Based Payment Models: States are exploring waivers to incentivize quality and outcomes rather than volume of services.
- Work Requirements & Community Engagement: While controversial and often legally challenged, some states continue to pursue waivers that include work requirements or community engagement requirements for certain beneficiaries.
- Coverage Expansions: States are seeking waivers to expand Medicaid eligibility to cover specific populations,
