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1115 waiver

What is a 1115 waiver?

A 1115 waiver, also called an 1115 demonstration, is requested by – and in some cases approved by –  a state that wants to make experimental or pilot demonstration changes to its Medicaid program.

Section 1115 of the Social Security Act gives the Secretary of HHS the authority to approve a state’s 1115 waiver/demonstration proposal as long as it’s determined that the state’s proposal will “assist in promoting the objectives” of the Medicaid program.

The Trump administration took a more relaxed approach in terms of what changes a state could make with an 1115 waiver, and notified governors in 2017 of their “intent to use existing Section 1115 demonstration authority to review and approve meritorious innovations that build on the human dignity that comes with training, employment, and independence.”

This ushered in an era of states submitting Medicaid work requirement (“community engagement”) proposals as 1115 demonstrations, several of which were approved by the Trump administration. None are in effect as of 2021, however, and Medicaid work requirements are not likely to be approved under the Biden administration.

1115 waivers have made headlines over the last few years as a result of the Trump administration’s interpretation of how they can be used, and it’s often the case that 1115 waivers are discussed in relation to Medicaid work requirements. But 1115 waivers have been around for decades, and are used for a wide range of innovative changes to states’ Medicaid program.

CMS has a webpage that shows a state-by-state list of approved, pending, and terminated 1115 waivers.

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Twelve states received federal approval for Medicaid work requirements, but the Biden administration has since revoked approval for all of them.