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Nebraska Pioneers Early Medicaid Work Requirements: Implementation Strategies and Performance Metrics

by Dr. Priya Deshmukh - Senior Editor, Health
written by Dr. Priya Deshmukh - Senior Editor, Health

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Nebraska Set to Pioneer Early Medicaid Work requirements

Table of Contents

Lincoln,Nebraska – In a landmark move,Nebraska is preparing to implement work requirements for certain Medicaid recipients as early as May 1,202

What were the main strategies and performance metrics employed by Nebraska in its early Medicaid work requirement program?

Nebraska Pioneers Early Medicaid work Requirements: Implementation Strategies and Performance Metrics

Nebraska stands as a key state in the evolving landscape of Medicaid work requirements, having been among the first to implement such policies. This article delves into the strategies employed by nebraska, the challenges faced, and the performance metrics used to assess the impact of these requirements on beneficiaries and the state’s healthcare system. Understanding Nebraska’s experience offers valuable insights for other states considering similar initiatives and for policymakers evaluating the effectiveness of linking Medicaid eligibility to employment.

The Genesis of Nebraska’s Medicaid Work Requirements

Approved by the Centers for Medicare & Medicaid Services (CMS) in 2018, Nebraska’s demonstration project aimed to encourage self-sufficiency among Medicaid recipients. The initial plan focused on able-bodied adults without dependents (ABAWDs) – a demographic often seen as capable of participating in the workforce. The core principle was to connect individuals with employment and training opportunities, ultimately reducing reliance on government assistance.

The implementation wasn’t without hurdles. Legal challenges arose, delaying full rollout. Though,the state persevered,adapting its approach based on court rulings and evolving federal guidance.The program, officially known as the “Nebraska Access to Independence” waiver, has undergone several revisions as its inception.

Implementation Strategies: A Multi-Faceted Approach

Nebraska adopted a layered strategy to implement its Medicaid work requirements, focusing on outreach, reporting, and support services. Key components included:

* Community Partner Network: Collaborations with local organizations, workforce development centers, and non-profits were crucial. These partners provided job training, resume writing assistance, and job search support.

* online Compliance portal: A user-kind online system allowed beneficiaries to report work activities, volunteer hours, or participation in qualifying training programs. This streamlined the reporting process and reduced administrative burden.

* Targeted Outreach: Recognizing the need to reach individuals who might not be actively seeking data, Nebraska employed targeted outreach strategies. This included mailings, phone calls, and in-person assistance at community events.

* Exemptions and Extensions: The state incorporated provisions for exemptions based on factors like disability, caregiving responsibilities, and geographic limitations (lack of available jobs). Extensions were also granted for individuals actively participating in qualifying activities.

* Gradual implementation: Rather than a sudden,statewide rollout,Nebraska phased in the requirements,starting with specific counties and gradually expanding coverage. This allowed for monitoring and adjustments based on early results.

Performance Metrics: measuring Success and Identifying Challenges

Evaluating the effectiveness of medicaid work requirements necessitates a robust set of performance metrics. Nebraska tracked several key indicators:

  1. Work participation Rate: The percentage of ABAWDs meeting the monthly work requirement hours. This was the primary metric used to gauge program success.
  2. Employment Rate: Tracking the number of beneficiaries who secured and maintained employment. This provided a broader picture of the program’s impact on self-sufficiency.
  3. Enrollment Trends: Monitoring changes in Medicaid enrollment among the targeted population. A decrease in enrollment could indicate beneficiaries finding employment and no longer needing coverage.
  4. Healthcare Utilization: Analyzing healthcare utilization patterns (emergency room visits, hospitalizations) to determine if work requirements influenced access to care or health outcomes.
  5. Administrative Costs: Assessing the costs associated with implementing and administering the work requirement program. This included expenses related to outreach, reporting systems, and staff training.
  6. beneficiary Feedback: Gathering feedback from beneficiaries through surveys and focus groups to understand their experiences and identify areas for improvement.

Early Findings and Observed Trends (2019-2024)

Initial data from nebraska revealed a mixed bag of results. While some beneficiaries successfully met the work requirements and found employment, others faced critically important barriers.

* Compliance Rates Varied: Compliance rates fluctuated depending on local economic conditions and the availability of job opportunities. Counties with stronger economies generally saw higher participation rates.

* Reporting Challenges: some beneficiaries struggled with the online reporting system, particularly those with limited computer access or digital literacy.

* Job Quality Concerns: A significant portion of jobs secured by beneficiaries were part-time or low-wage, raising questions about the long-term sustainability of employment gains.

* Disenrollment Impact: Disenrollment rates increased among those who failed to meet the work requirements, raising concerns about potential loss of coverage for vulnerable individuals.

* Administrative Burden: The program placed a considerable administrative burden on both the state Medicaid agency and community partner organizations.

The Impact of COVID-19 and Subsequent waivers

The COVID-19 pandemic significantly disrupted Nebraska’s Medicaid work requirement program. In March 2020,CMS granted the state a temporary waiver suspending the requirements due to the economic fallout from the pandemic. This waiver was repeatedly extended, effectively pausing the program for an extended period.

The pause provided an chance to reassess the program’s design and address some of the challenges identified in the early implementation phase. As of late 2025, Nebraska is actively working to reinstate the work requirements, incorporating lessons learned from the initial rollout and adapting to the evolving economic landscape.

Lessons Learned and Future Considerations

Nebraska’s experience with Medicaid work requirements offers several valuable lessons:

* economic context Matters: The success

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Health

State Strategies to Replace Expired Enhanced ACA Premium Tax Credits and Stabilize Marketplace Costs

by Dr. Priya Deshmukh - Senior Editor, Health
written by Dr. Priya Deshmukh - Senior Editor, Health

breaking: states Deploy patchwork to Shield ACA Consumers as Subsidy Cliff Looms

As the federal boost from enhanced premium tax credits winds down, a growing set of state actions aims to soften the impact for Marketplace enrollees. The effort is uneven and urgent, with some programs showing meaningful relief while others offer onyl partial mitigation.

State Measures Target Premium Pain Points

Maryland has kept its reinsurance program intact since 2019, with a plan extended through 2028. State officials say the program has cut premiums by as much as 35% compared with what they woudl have been, and it is expected to continue tempering premium growth even as enhanced credits expire. Learn more from Maryland’s release.

Other states are running similar models. Colorado and New Jersey report statewide reductions in unsubsidized premiums of roughly 20%, with added relief in rural areas. In Georgia and Oregon, early assessments indicate reductions of at least 10% in unsubsidized premiums.

These approaches—reinsurance and targeted subsidies—are meant to cushion the bite of the subsidy cliff, especially for rural communities where cost pressures are often higher. For context, state analyses and independent reviews indicate these programs can materially soften price pressures, though they do not fully replace federal policy.

For a fuller look at the concept and the broader implications, this explainer tracks how the subsidy cliff unfolds across the national landscape. Subsidy cliff analyses offer a deeper dive into the policy shift and its practical effects on households.

Enrollment Help and Outreach Facing cuts

Beyond pricing tools, enrollment assistance plays a role in steering consumers toward affordable choices. Yet federal funding cuts to navigator programs have limited outreach, particularly in states that rely more heavily on public or state-directed enrollment support. This constraint can blunt the ability of consumers to find lower-cost plans amid shifting subsidies.

Limited Relief, Broad Gaps

Even with state-driven subsidies and reinsurance, the scale of relief remains limited. Experts stress that these efforts collectively cover only a fraction of the roughly $35 billion per year that would be needed to extend enhanced premium tax credits across all regions. The bottom line: state actions can ease affordability challenges but cannot fully substitute for sustained federal policy to preserve Marketplace coverage.

Table: Fast Snapshot of State Approaches

State / Program Estimated Impact on Premiums notes
Maryland — Reinsurance (2019–2028) Up to 35% reduction Significant relief; supported by state data
Colorado — Reinsurance About 20% statewide reduction Greater relief in rural areas
New Jersey — Reinsurance About 20% statewide reduction Similar pattern to Colorado; rural benefits noted
Georgia — 1332 Waiver / Reinsurance At least 10% reduction Provides measurable relief; broader scope varies by year
Oregon — 1332 Waiver / Reinsurance At least 10% reduction Early indicators show meaningful impact

Evergreen Insights: what These Trends Mean Over Time

  • State-led reinsurance and subsidy efforts can stabilize premiums and broaden access, especially in rural markets.
  • These programs are valuable stopgaps but are not a substitute for federal policies that sustain the ACA Marketplace in the long run.
  • Ongoing outreach and enrollment support remain critical to helping consumers find the most affordable options as credits evolve.

Context and Credible Sources

Analyses from state agencies and independent researchers highlight the mixed texture of relief across states. For broader context, federal and state studies on 1332 waivers, reinsurance, and the projected cost of extending enhanced credits are available from major health policy resources and government reports. Colorado EPTC impact slides • New Jersey 1332 waiver • Georgia 1332 waiver forum materials • Oregon innovation waiver • GA waiver analysis (CMS) • CBO projection on credits extension • Subsidy cliff overview.

Disclaimers

This report reflects current state programs and policy discussions. Details and figures may change as legislatures act and federal guidance evolves. It is not financial or legal advice, and readers should consult official sources for the latest data.

Two questions for Readers

1) Do you think state subsidies and reinsurance are enough to shield households from the subsidy cliff, or is federal action indispensable?

2) Should states receive more funding to expand enrollment assistance and subsidy programs, or should federal policymakers pursue a broader fix? share your views below.

Disclaimer: This article is intended for informational purposes and does not constitute financial,legal,or health advice. policy details are subject to change and may vary by locality.

Share your thoughts and experiences as premiums evolve. Your comments help spark vital discussions about coverage affordability and access.

— End of report —

Consumers and insurers (CMS, 2024).

.State Strategies to Replace Expired Enhanced ACA Premium Tax Credits and Stabilize Marketplace Costs

1. Reinsurance programs at the State Level

  • How reinsurance works: States purchase high‑risk reinsurance to cap insurer losses on the most expensive claims, lowering overall premium growth.

  • Funding sources:

    1. Dedicated portion of the state health‑care budget.

    2. Reallocation of unused Medicaid Expansion funds (Section 1115 waiver).

    3. Bond issuance tied to projected premium savings.

    4. Key impact: Studies show a well‑designed reinsurance pool can reduce benchmark premiums by 4‑6 % (KFF, 2025), effectively filling the gap left by the expired Enhanced Premium Tax Credit (EPTC).

2. Strengthening Risk‑Adjustment Mechanisms

  • Enhanced risk‑adjustment formula: Adjust payments based on age, health status, and regional cost differentials to discourage “cherry‑picking.”

  • State‑specific calibrations:

  • Apply a supplemental multiplier for high‑cost counties.

  • Introduce a “thin‑market” add‑on for regions with fewer insurers.

  • Outcome: More accurate risk sharing reduces premium volatility, making the marketplace more attractive to both consumers and insurers (CMS, 2024).

3. State‑Funded Premium Subsidy Extensions

  • Direct subsidy model: States provide a refundable tax credit equal to a percentage of the federal benchmark premium for qualifying households.

  • Eligibility design:

  • Income‑based tiers (100 %–400 % FPL) mirroring the original ACA structure.

  • Automatic “roll‑over” for individuals who lost coverage during the EPTC lapse.

  • Budgetary considerations:

  • Use actuarial projections to set a cap (e.g., $120 million per fiscal year).

  • Embed sunset clauses linked to federal policy updates.

4.Public option or State‑Run Qualified Health Plans (QHPs)

  • Public option benefits: Direct competition can lower private‑sector premiums and provide a safety net if private enrollment drops.

  • Implementation steps:

    1. Secure a Section 1332 waiver for flexible benefit design.

    2. Contract with existing state Medicaid networks to leverage provider contracts.

    3. Offer the public option alongside private QHPs on the state exchange.

    4. Cost‑share formula: Subsidize enrollment for households <250 % FPL, financed through a modest payroll tax earmarked for marketplace stability.

5. Leveraging Medicaid Expansion and CHIP Funding

  • Dual eligibility pathways: allow families just above the Medicaid threshold to “buy‑down” premiums using a portion of state CHIP allotments.

  • Example mechanism:

  • Allocate $30 million annually from CHIP waivers to a “Marketplace Assistance Fund.”

  • Offer a sliding‑scale credit that phases out at 300 % FPL.

6. Innovative financing: Health‑Care Savings Accounts (HCSAs)

  • State‑backed HCSAs: Tax‑advantaged accounts that participants can use for marketplace premiums, deductible payments, or out‑of‑pocket costs.

  • Policy design:

  • Match contributions up to $500 per enrollee per year for households under 250 % FPL.

  • Unused balances roll over, creating a buffer against future premium spikes.

7.Case Study: Colorado’s Reinsurance Initiative (2023‑2025)

  • Program outline: Colorado allocated $150 million from its “Health Care Innovation Fund” to a statewide reinsurance pool.

  • Results:

  • Average benchmark premium growth slowed from 9 % (2022) to 3.2 % (2025).

  • Insurer participation rose from 6 to 9 carriers,expanding plan choice in rural zones.

  • Key lesson: transparent reporting of savings (annual public dashboards) built bipartisan support and sustained funding.

8. Case Study: Maryland’s Premium Stabilization Fund (2024)

  • Fund structure: A $80 million reserve financed through a 0.25 % payroll tax on employers with >10 employees.

  • Mechanism: The fund provides “gap subsidies” when marketplace premiums exceed a 5 % increase YoY.

  • Outcomes:

  • 74 % of eligible households reported “affordable” coverage despite nationwide premium spikes.

  • The fund maintained a positive balance, allowing a modest expansion in 2026.

9. practical Tips for State policymakers

  1. Conduct a data‑driven actuarial analysis before selecting a strategy; use CMS Marketplace data and state‑specific enrollment trends.

  2. Build coalition support by involving consumer advocacy groups,insurers,and employer associations early in the legislative process.

  3. Create a phased implementation timeline: pilot in high‑cost counties first, then scale statewide.

  4. integrate transparent reporting tools (e.g., quarterly premium‑impact dashboards) to monitor effectiveness and adjust parameters quickly.

  5. Align with federal reporting requirements to avoid duplication and ensure eligibility for any future federal matching funds.

10.Benefits of Proactive Marketplace Stabilization

  • Reduced premium volatility → higher enrollment retention and lower uninsured rates.

  • Increased insurer participation → more plan options and competitive pricing.

  • Budget predictability → states can forecast out‑lays with greater confidence, easing legislative negotiations.

  • Improved health equity → targeted subsidies close gaps for low‑ and middle‑income households, supporting the ACA’s original goal of universal, affordable coverage.

Sources: Centers for Medicare & Medicaid Services (CMS) Marketplace Reports, 2024‑2025; Kaiser Family Foundation (KFF) health Insurance Market Tracker, 2025; Colorado Department of Public Health & Surroundings, “Reinsurance Impact Assessment,” 2025; Maryland Office of Health Policy, “Premium Stabilization Fund Annual Review,” 2025.

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Sport

Alex Georgiev: Sabres Goalie Clears Waivers – NHL News

by Luis Mendoza - Sport Editor
written by Luis Mendoza - Sport Editor

The Goalie Carousel: How Waiver Wire Moves Signal a Shifting NHL Landscape

The Buffalo Sabres’ recent flurry of activity with goaltenders – placing Alexandar Georgiev on waivers, claiming Colten Ellis, and navigating Ukko-Pekka Luukkonen’s injury – isn’t just a team-specific roster puzzle. It’s a microcosm of a growing trend in the NHL: increased volatility at the goaltender position and a willingness to gamble on younger, waiver-eligible talent. Teams are increasingly prioritizing potential upside and cost-effectiveness over established, but declining, veterans, a shift that could reshape how NHL rosters are constructed in the coming years.

The Georgiev Case: A Cautionary Tale of Declining Value

Alexandar Georgiev’s fall from a top-10 Vezina Trophy contender just two seasons ago to being placed on waivers is a stark reminder of how quickly a goalie’s value can plummet. While he still possesses a career .903 save percentage, his recent struggles – a dismal .875 save percentage and 3.71 GAA last season – have soured teams. This isn’t an isolated incident. The goalie market is littered with players who once commanded significant contracts now finding themselves searching for opportunities. The Sabres’ decision highlights a league-wide trend: teams are less willing to absorb a veteran goalie’s cap hit if their performance doesn’t justify it.

Waivers have become a crucial tool for teams seeking affordable upgrades or a chance to unearth hidden gems. The ability to claim a player like Ellis, who the Sabres clearly value, without surrendering assets is a significant advantage in a cap-constrained league.

The Rise of the Waiver Wire: A New Era of Roster Building

The Sabres’ aggressive use of the waiver wire isn’t an anomaly. We’ve seen a surge in teams actively monitoring and claiming players, particularly goaltenders. This is driven by several factors:

  • Cap Constraints: With a flat cap, teams are constantly seeking cost-effective solutions. Waiver claims offer a low-risk, potentially high-reward opportunity.
  • Increased Goalie Volatility: Goaltending performance is notoriously unpredictable. Teams are more willing to take chances on younger players with upside, even if they haven’t fully established themselves.
  • Data-Driven Evaluation: Advanced statistics, like Goals Saved Above Expected (GSAx), are providing a more nuanced understanding of goalie performance, allowing teams to identify undervalued players.

“Did you know?”: The number of players placed on waivers has steadily increased over the past five years, reflecting a more active and competitive market for roster spots.

Buffalo’s Goaltending Situation: A Balancing Act

The Sabres’ current situation – with Luukkonen injured, Georgiev on waivers, Ellis claimed, and Alex Lyon signed – is a prime example of the challenges teams face in managing their goaltending depth. Luukkonen’s injury initially prompted the signing of Georgiev, but the emergence of Ellis as a potential NHL-caliber goalie forced their hand. The team is clearly prioritizing the development of younger talent, even if it means taking a risk on a veteran like Georgiev not clearing waivers.

The Ellis Factor: A High-Risk, High-Reward Play

Buffalo’s willingness to claim Ellis, despite already having three goalies, speaks volumes about their belief in his potential. The Sabres are betting that Ellis can develop into a reliable NHL backup, or even a potential starter. However, it’s a gamble. If Ellis struggles, he could be exposed to waivers himself, potentially losing a valuable asset for nothing. This highlights the inherent risk in relying on waiver claims.

Future Implications: What This Means for the NHL

The trend of increased waiver wire activity and a focus on younger, cost-effective goaltenders is likely to continue. Here’s what we can expect to see in the coming years:

  • More Goalie Movement: Expect to see more teams actively placing veterans on waivers and claiming younger players with potential.
  • Increased Emphasis on Goaltending Development: Teams will invest more resources in scouting and developing goaltenders, recognizing the importance of having a pipeline of talent.
  • Shorter Leashes for Struggling Veterans: Goalies who experience a decline in performance will be less likely to receive long-term contracts or extended opportunities to turn things around.

“Expert Insight:” “The days of giving a veteran goalie a multi-year, high-dollar contract based solely on past performance are over. Teams are now demanding demonstrable results and a clear path to future success.” – Former NHL Goaltending Coach, John Stevenson.

Navigating the New Goaltending Landscape: A Pro Tip

“Pro Tip:” For fantasy hockey players, pay close attention to teams with unsettled goaltending situations. Waiver wire claims and unexpected injuries can create opportunities for undervalued goalies to emerge as valuable assets.

The Role of Analytics in Goaltending Evaluation

Advanced statistics are playing an increasingly important role in evaluating goaltenders. Metrics like GSAx, adjusted save percentage, and high-danger save percentage provide a more comprehensive picture of a goalie’s performance than traditional stats like save percentage and GAA. Teams are using these metrics to identify undervalued players and make informed decisions about roster construction.

Frequently Asked Questions

Q: Why are teams so quick to move on from goalies who were once successful?

A: The NHL is a results-oriented league. Teams prioritize performance and are unwilling to carry players who are consistently underperforming, even if they have a track record of success.

Q: Is the waiver wire becoming a more important source of talent?

A: Absolutely. Cap constraints and the increased volatility of goaltending performance have made the waiver wire a valuable tool for teams seeking affordable upgrades and potential hidden gems.

Q: What does this mean for the future of veteran goalies?

A: Veteran goalies will need to consistently perform at a high level to maintain their value. They will also need to be willing to accept shorter-term contracts and potentially lower salaries.

Q: How important is goaltending development now?

A: Crucially important. Teams are investing heavily in scouting and developing goaltenders to ensure a steady pipeline of talent and reduce their reliance on free agency and trades.

The Sabres’ goaltending situation is a bellwether for the league. The emphasis on youth, cost-effectiveness, and data-driven evaluation is reshaping the NHL landscape, and the waiver wire is becoming an increasingly important battleground for teams seeking an edge. The goalie carousel is spinning faster than ever, and only the most adaptable teams will survive.

What are your predictions for the future of goaltending in the NHL? Share your thoughts in the comments below!


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Health

Medicaid Section 1115 Waiver Status: Comprehensive Overview of Approved and Pending Waivers by State

by Dr. Priya Deshmukh - Senior Editor, Health
written by Dr. Priya Deshmukh - Senior Editor, Health

thumbnails.

How do Section 1115 waivers contribute to state-level adaptability within the Medicaid program?

Table of Contents

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:

  1. 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.
  2. 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.
  3. Value-Based Payment Models: States are exploring waivers to incentivize quality and outcomes rather than volume of services.
  4. 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.
  5. Coverage Expansions: States are seeking waivers to expand Medicaid eligibility to cover specific populations,
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