Medicaid Waiver Map

Last Updated

Use this interactive map to help you determine if your state has a Section 1115 Medicaid waiver and the impact on Medicaid beneficiaries living with or at risk for HIV and hepatitis. Please see NASTAD’s related Medicaid resources: Medicaid 1115 Waivers: Considerations for HIV and Hepatitis Programs and Medicaid 1115 Waivers: Exemptions for People Living with HIV and Hepatitis. Additional information about approved and pending waivers can be found on the Centers for Medicare & Medicaid Services website.

This map was produced as part of a project supported by the Elton John AIDS Foundation.

Last Updated: December 16, 2021

Map

Waiver Status

Approved
Pending
No Waiver
Premiums
Yes
No
Work Requirements
Yes
No
Enrollment Time Limit/Lifetime Cap
Yes
No
SUD/Behavioral Health
Yes
No
HIV- or Hepatitis-Specific Exemptions
Yes
No

Alabama

Pending

Alabama Section 1115 Institutions for Mental Disease Waiver for Serious Mental Illness

  • Status: Pending
  • Demonstration populations: All Medicaid enrollees age 21-64 approved for full Medicaid coverage, with some exceptions.
  • Proposed amendment would authorize inpatient behavioral health services for short-term residents in residential and inpatient treatment settings that qualify as an IMD. The waiver would be limited to IMDs operating in Mobile, Washington, and Baldwin counties, but Medicaid enrollees residing in any Alabama county may access services.
  • State Resources
  • Federal Application (March 2021)

 Alabama Medicaid Workforce Initiative

  • Status: Withdrawn
  • UPDATE—February 2021: The state withdrew its application, which would have imposed work requirements as a condition of eligibility for “able-bodied” adults age 19-59 in the low-income Parents and Caretaker Relatives and Transitional Medical Assistance (TMA) eligibility groups. Individuals who failed to meet work requirements would have be disenrolled.
  • State Resources
  • Comments and letters from national organizations regarding Alabama’s waiver may be found here.

 

Alaska

Approved

Alaska Substance Use Disorder and Behavioral Health Program

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Provides an enhanced set of community-based mental health, behavioral health, and substance use treatment benefits.
  • State Resources
  • Federal Approval

 

American Samoa

No Waiver

Arizona

Pending

Arizona Health Care Cost Containment System 

  • Status: Renewal and Amendments Pending
  • Demonstration populations: All Medicaid enrollees.
  • Enacts payment and delivery reforms to improve behavioral health services, including incentive payments to providers for increasing physical and behavioral health care integration and coordination.
  • Eliminates retroactive eligibility for non-pregnant adults.
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • Proposed amendment would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed extension request would allow Arizona to continue most of its current programs. However, Arizona requested to discontinue premium requirements and healthy behavior incentives for Medicaid expansion enrollees above 100% FPL through contributions to AHCCCS CARE account (which was previously approved but never implemented).
  • Proposed amendment would expand housing services and interventions for individuals experiencing homelessness or at risk of becoming homeless who meet at least one other criterion, including but not limited to individuals with a serious mental illness, individuals in need of substance use treatment, individuals determined high-risk or high-cost based on service utilization or health history, individuals with chronic conditions (including HIV/AIDS or SUD), and individuals at high risk of experiencing homelessness upon release from an institutional setting (including IMDs or incarceration settings).
  • REJECTED: CMS rejected the state’s proposal to impose a five-year lifetime coverage limit for individuals who fail to comply with work requirements.
  • UPDATE—June 24, 2021: CMS has withdrawn its prior approval of Arizona’s work requirements. CMS previously senta letter to the state, to which the state did not respond, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • UPDATE—October 17, 2019: Arizona postponed implementation of work requirements until further notice. Work requirements were set to take effect no earlier than January 2020 and expire on September 30, 2021.
  • State Resources
  • Federal Approval
  • Federal Application (Housing and Health Opportunities Amendment, May 2021)
  • Federal Application (Extension Request, December 2020)
  • Federal Application (IMD Waiver Amendment, May 2017)
  • HIV Health Care Access Working Group Comments on Arizona 1115 Waiver (December 2015)
  • Comments and letters from national organizations regarding Arizona’s waiver may be found here.

 

Arkansas

Pending

Arkansas Works 

  • Status: Approved
  • Demonstration populations: Medicaid expansion adults.
  • Premium assistance model for purchase of Marketplace Qualified Health Plans (QHPs) for Medicaid expansion population, except for medically frail enrollees and AI/AN individuals.
  • Imposes premiums for enrollees with incomes above 100% FPL. Unpaid premiums may be deducted from an enrollee’s state income tax refund.
  • Shorten the retroactive eligibility period for expansion adults from 90 to 30 days.
  • UPDATE—March 17, 2021: CMS has withdrawn its prior approval of Arkansas’ work requirements. CMS previously senta letter to the state, to which the state responded, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • UPDATE—February 14, 2020: A federal appeals court upheld the March 2019 court decision, and ruled that the Arkansas waiver approval violated federal law.
  • UPDATE—March 27, 2019: Arkansas’ March 5, 2018 waiver approval was invalidated following a lawsuit in federal court, on the grounds that HHS violated federal law when it approved the waiver without considering whether the waiver furthered the objectives of the Medicaid program.
  • State Resources
  • Federal Approval
  • NHeLP Comments on Arkansas 1115 Waiver Amendments (August 2016)
  • Comments and letters from national organizations regarding Arkansas’ waiver may be found here.

 Arkansas Health and Opportunity for Me (ARHOME)

  • Status: Pending
  • Demonstration populations: Medicaid expansion adults.
  • Proposal would replace existing Arkansas Works demonstration approval.
  • Proposal would maintain approvals under Arkansas Works for premium assistance, shortened retroactive eligibility period, and premiums. Premiums would be higher than under the currently approved Arkansas Works demonstration.
  • Proposal would reinstate work requirements (previously withdrawn by CMS) as an “economic independence” incentive rather than a condition of eligibility. Enrollees who fail to complete certain employment, education, or training activities may be subject to higher cost-sharing or premiums, or re-assigned from a QHP to fee-for-service.
  • Proposal would allow QHPs to incentivize enrollee participation in health improvement initiatives (e.g., use of preventive services, completion of health assessments). Enrollees who fail to complete these activities may be subject to higher cost-sharing or premiums, or re-assigned from a QHP to fee-for-service.
  • State Resources
  • Federal Application (July 2021)
  • Comments and letters from national organizations regarding Arkansas’ waiver may be found here.

California

Pending

Medi-Cal 2020 Demonstration

  • Status: Renewal and Amendment Pending
  • Demonstration populations: Select eligibility groups, including but not limited to Medicaid expansion adults, seniors, persons with disabilities, parent and caretaker relatives, certain children, children with special needs, and pregnant persons.
  • 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.
  • “Health home” initiative 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.
  • Authorizes pilot program programs to support infrastructure development to integrate services for enrollees with mental health or substance use disorders.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Amends the demonstration to end California’s Designated State Health Program (DSHP). DSHP provided federal funds to otherwise state-funded programs, including the AIDS Drug Assistance Program (ADAP).
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • State Resources
  • Federal Approval
  • Federal Application (June 2021)
  • Comments and letters from national organizations regarding California’s waiver may be found here.

 

Colorado

Approved

Expanding the Substance Use Disorder Continuum of Care

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Connecticut

Pending

Connecticut Substance Use Disorder Demonstration

    • Status: Pending
    • Demonstration populations: All Medicaid enrollees.
    • Proposal would authorize inpatient behavioral health services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
    • State Resources
    • Federal Application (August 2021)

Delaware

Approved

Diamond State Health Plan 

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Eliminates retroactive eligibility for non-pregnant adults.
  • Expands community-based behavioral health services.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Provides preventative and restorative dental care coverage.
  • The state has received approval for an amendment in order to respond to the COVID-19 pandemic.
  • State Resources
  • Federal Approval

Federated States of Micronesia

No Waiver

Florida

Pending

Florida Managed Medical Assistance Program 

  • Status: Amendment Pending
  • Demonstration populations: All Medicaid enrollees, certain aged or disabled individuals who are not otherwise eligible for Medicaid, and certain individuals living with AIDS who are not otherwise eligible for Medicaid.
  • Extends most waiver provisions for 10 years. The behavioral health and supportive housing assistance pilots are extended for five years.
  • Provides coverage for individuals diagnosed with AIDS with income at or below 222% FPL and assets not exceeding $2,000 (for an individual) who are not otherwise eligible for Medicaid.
  • Enrolls people living with HIV or AIDS in specialty plans, where available.
  • Eliminates retroactive coverage for non-pregnant adults.
  • Includes community behavioral health providers as participating providers under the Low Income Pool.
  • Authorizes a pilot program to provide behavioral health and supportive housing assistance services for enrollees age 21 and older with serious mental illness and/or substance use disorder who are homeless or at risk of homelessness due to disability.
  • Proposed amendment would extend postpartum coverage from 60 days to 12 months, with continuous eligibility throughout the postpartum period.
  • Proposed amendment would remove requirement that the state submit an annual letter to CMS to allow continued authorization of retroactive coverage waiver.
  • State Resources
  • Federal Approval
  • Federal Application (September 2021)
  • Comments and letters from national organizations regarding Florida’s waiver may be found here.

Georgia

Approved

Georgia Pathways to Coverage

  • Status: Approved
  • Demonstration populations: Adults age 19-64 with income up to 100% FPL who are not otherwise eligible for Medicaid.
  • Implements partial expansion for adults age 19-64 up to 100% FPL who are already working or participating in work-related activities for 80 hours per month. The state’s waiver does not provide for any exemptions for applicants who do not meet the work requirements upon their initial application. Applicants with incomes above 50% FPL must also make an initial premium payment before their coverage can begin.
  • Imposes work requirement as a condition of eligibility for all demonstration enrollees, with disenrollment and three-month lockout for failure to comply. Re-enrollment within three months is contingent upon proof of compliance. Members who demonstrate compliance for six consecutive months will be exempt from reporting compliance for the remainder of the 12-month benefit year, but the state will perform periodic and random audits to verify compliance. The work requirement is not yet in effect, but is set to be implemented July 1, 2021.
  • Imposes premiums for enrollees with incomes at or above 50% FPL, through contributions to a Member Rewards Account. Enrollees will be suspended after two months of non-payment and disenrolled after three months of non-payment, and may re-apply for coverage at any time following disenrollment.
  • Imposes approximately 50% tobacco premium surcharge.
  • Implements Member Rewards Accounts for enrollees with incomes at or above 50% FPL. Accounts are funded with enrollee premiums, as well as with state funds for completion of healthy behavior activities. Copayments will be deducted from account balances. Beneficiaries are not responsible for negative balances, but future premium payments or healthy behavior incentive payments will be used to offset a negative balance. Once an enrollee’s account balance reaches $50, funds may be used to pay for certain health-related expenses not covered by Medicaid (such as over-the-counter drugs, dental services, and glasses).
  • Imposes copayments for enrollees with incomes at or above 50% FPL. Copayments are not paid to providers at the point of service, but are instead assessed retrospectively for services already received. Copayments are deducted from Member Rewards Accounts, which may result in a negative balance if the account has insufficient funds. Future premium payments and healthy incentive points will be applied to the balance.
  • Eliminates retroactive eligibility for people enrolled through the demonstration.
  • Eliminates hospital presumptive eligibility for people enrolled through the demonstration.
  • Eliminate non-emergency medical transportation (NEMT) for all enrollees, except enrollees eligible for EPSDT services.
  • Allows for waiting periods. Enrollment begins at the start of the month following the state’s eligibility determination, or the month following the initial premium payment for enrollees that must pay premiums. Applicants must also demonstrate compliance with work requirements in order to gain coverage.
  • UPDATE—July 27, 2021: Georgia has delayed implementation of the waiver until the end of 2021 to resolve concerns CMS identified in its February 12, 2021 letter.
  • UPDATE—February 12, 2021: CMS senta letter to the state, to which the state responded, explaining that it is beginning the process of determining whether to withdraw the state's previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • State Resources
  • Federal Approval
  • Comments and letters from national organizations regarding Georgia’s waiver may be found here.

Georgia Postpartum Extension

  • Status: Approved
  • Demonstration populations: Enrollees in any Medicaid eligibility group whose 60-day postpartum period is ending, and any persons not enrolled in Medicaid who are within the six-month postpartum period and meet all other Medicaid eligibility criteria.
  • Extends postpartum coverage from 60 days to six months for individuals with income up to 225% FPL, with continuous eligibility throughout the postpartum period.
  • Federal Approval
  • Comments and letters from national organizations regarding Georgia’s waiver may be found here.

Guam

No Waiver

Hawaii

Approved

Hawaii QUEST Integration 

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Provides community integration services for beneficiaries who are homeless or at risk of homelessness, and who also have a behavioral health need, complex physical health need, or a substance use need.
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • State Resources
  • Federal Approval

 Hawaii COVID-19 Public Health Emergency Demonstration

Idaho

Pending

Idaho Medicaid Reform Waiver

  • Status: Pending
  • Demonstration populations: Medicaid expansion adults.
  • Proposal would impose work requirements for expansion adults age 19-59, with disenrollment and two-month lockout for failure to comply.
  • State Resources
  • Federal Application (October 2019)
  • Comments and letters from national organizations regarding Idaho’s waiver may be found here.

Idaho Behavioral Health Transformation

 

Illinois

Approved

Illinois Behavioral Health Transformation

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Authorizes 10 SUD pilot projects that provide case management, withdrawal management, peer recovery, tenancy support, and other services to various populations in need of SUD care.
  • Expands community-based behavioral health benefits.
  • State Resources
  • Federal Approval
  • AIDS Foundation of Chicago Comments on Illinois 1115 Waiver (November 2016)

Illinois Continuity of Care and Administrative Simplification

  • Status: Approved
  • Demonstration populations: Enrollees in any Medicaid eligibility group whose 60-day postpartum period is ending, and any persons not enrolled in Medicaid who are within the six-month postpartum period and meet all other Medicaid eligibility criteria.
  • Allows managed care reinstatement within 90 days when a Medicaid beneficiary submits late redetermination paperwork, rather than requiring reinstatement into fee-for-service prior to going through the managed care enrollment process again, in order to reduce churn between fee-for-service and managed care.
  • Eliminates hospital presumptive eligibility.
  • Extends postpartum coverage from 60 days to 12 months for individuals with income up to 213% FPL, with continuous eligibility throughout the postpartum period.
  • State Resources
  • Federal Approval
  • Comments and letters from national organizations regarding Illinois’s waiver may be found here.

Indiana

Approved

Healthy Indiana Plan (HIP) 2.0 

  • Status: Approved
  • Demonstration populations: Medicaid expansion adults, Parents and Caretaker Relatives, Adult Transitional Medical Assistance (TMA), and pregnant persons with incomes up to 133% FPL. However, SUD treatment services in IMDs are available to all Medicaid enrollees.
  • Approves most provisions of the Healthy Indiana Program for 10 years (through December 31, 2030). SUD authorities and lock-outs for failure to pay premiums are approved through December 31, 2025. However, lockouts are conditionally approved, contingent on the Supreme Court issuing a decision in Azar v. Gresham that legally authorizes lockout periods.
  • Establishes premiums through monthly contributions to a Personal Wellness and Responsibility (POWER) account. Disenrollment with 6-month lockout for failure to pay premiums (>100% FPL only) is conditionally approved, contingent on the Supreme Court issuing a decision in Azar v. Gresham that legally authorizes lockout periods. Medically frail are exempt from lockout for non-payment.
  • Premiums are optional for beneficiaries with incomes below 100% FPL, but those who do not pay premiums get fewer benefits and must pay cost-sharing charges.
  • Eliminates non-emergency medical transportation (NEMT) for all enrollees except people who are pregnant, medically frail enrollees, and parent and caretaker relatives.
  • Eliminates retroactive coverage for non-pregnant adults.
  • Allows for waiting periods. Enrollment begins the month following the initial premium payment, or after the 60-day premium payment period expires for enrollees <100% FPL who opt not to pay premiums.
  • Imposes 50% tobacco premium surcharge.
  • Disenrollment for failure to complete annual redetermination on time, with 3-month lockout if redetermination is not completed within 90 days of disenrollment. Lockouts are conditionally approved, contingent on the Supreme Court issuing a decision in Azar v. Gresham that legally authorizes lockout periods.
  • Authorizes SUD and mental health treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • HIV and “chronic” hepatitis B and C included in medically frail condition list, but exemption may not be automatic. Medically frail are exempt from lockout periods and non-emergency medical transportation waiver.
  • UPDATE—June 24, 2021: CMS has withdrawn its prior approval of Indiana’s work requirements. CMS previously senta letter to the state, to which the state responded, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • UPDATE—October 31, 2019: Indiana suspended implementation of work requirements until further notice, citing ongoing litigation in other states. Indiana previously received conditional federal approval, contingent on the Supreme Court issuing a decision in Azar v. Gresham that legally authorizes work requirements.
  • State Resources
  • Federal Approval
  • NHeLP Comments on Indiana 1115 Waiver Amendment (October 2019)
  • NHeLP Comments on Indiana 1115 Waiver Amendment (September 2019)
  • NHeLP Comments on Indiana 1115 Waiver Renewal (July 2017)
  • HIV Health Care Access Working Group Comments on Indiana 1115 Waiver (September 2014)
  • Comments and letters from national organizations regarding Indiana’s waiver may be found here.

Maternal Opioid Misuse Indiana Initiative

  • Status: Withdrawn
  • UPDATE—June 2, 2021: The state has withdrawn its proposal to extend postpartum coverage through a section 1115 waiver. The state will provide 12 months of postpartum coverage under the state plan option authorized by the American Rescue Plan Act beginning in April 2022.
  • Comments and letters from national organizations regarding Indiana’s waiver may be found here.

Iowa

Approved

Iowa Wellness Plan 

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Allows state to charge premiums to Medicaid expansion enrollees with income above 50% FPL after the first year of enrollment. Enrollees that engage in specified “healthy behaviors” will not be subject to premiums. Individuals with incomes above 100% FPL will be disenrolled for failure to pay premiums, but may re-enroll any time with no lockout period. Individuals with incomes at or below 100% FPL will not be disenrolled for failure to pay premiums, but will lose comprehensive dental benefits. The state has paused premium and copayment requirements until the COVID-19 emergency declaration is lifted.
  • Eliminates non-emergency medical transportation (NEMT) for all enrollees in the Medicaid expansion group, except for medically frail enrollees and those eligible for EPSDT.
  • Eliminates retroactive coverage for non-pregnant adults who are not eligible for nursing facility care.
  • Provides dental benefits to certain eligibility groups.
  • State Resources
  • Federal Approval
  • NHeLP Comments on Iowa 1115 Waiver Amendments (September 2017)
  • Comments and letters from national organizations regarding Iowa’s waiver may be found here.

 

Kansas

Pending

KanCare

  • Status: Amendments Pending
  • Demonstration populations: All Medicaid enrollees, with exceptions, and individuals not eligible for Medicaid enrolled in the Behavioral Health Employment Support Pilot.
  • Authorizes rehabilitation services designed to meet the more intensive needs of individuals with SUD in their community and avoid the need for inpatient hospitalization. Services are prior authorized and include various detox, treatment, and community-based services.
  • Expands community-based behavioral health benefits.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed amendment would implement 12-month continuous eligibility for Parents and Caretaker Relatives.
  • REJECTED: CMS rejected the state’s proposal to impose a 36-month lifetime coverage limit for individuals who are subject to work requirements.
  • UPDATE—December 18, 2018: The state has asked CMS to defer consideration of proposals to impose work requirements and to limit coverage for TMA enrollees.
  • State Resources
  • Federal Approval
  • Federal Application (Continuous Eligibility Amendment, August 2021)
  • Federal Application (HCAIP Amendment, July 2019)
  • NHeLP Comments on Kansas 1115 Waiver Renewal (January 2018)
  • Comments and letters from national organizations regarding Kansas’ waiver may be found here.

Kentucky

Pending

KY HEALTH 

  • Status: Amendment Pending
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Eliminates non-emergency transportation for methadone services. Medically frail, including people living with HIV and hepatitis, are exempt and may receive non-emergency medical transportation for methadone services.
  • Proposed amendment would authorize federal Medicaid matching funds for SUD treatment provided to adults with incomes at or below 138% FPL incarcerated in state and county facilities.
  • UPDATE—June 16, 2020: The state withdrew the components of its waiver that were invalidated by the court in March 2019, including work requirements, premiums, and disenrollments and lockouts for failure to comply with certain eligibility rules. CMS reissued its approval of the remaining provisions.
  • UPDATE—March 27, 2019: Kentucky's November 20, 2018 waiver approval has been invalidated following a lawsuit in federal court, on the grounds that HHS violated federal law when it approved the waiver without considering whether the waiver furthered the objectives of the Medicaid program.
  • State Resources
  • Federal Approval
  • Federal Application (November 2020)
  • CIDP Comments on Kentucky 1115 Waiver Resubmission (August 2018)
  • HIV Health Care Access Working Group Comments on Kentucky 1115 Waiver Resubmission (August 2018)
  • NHeLP Comments on Kentucky 1115 Waiver Resubmission (August 2018)
  • NHeLP Comments on Kentucky 1115 Waiver (October 2016)
  • AAHIVM Comments on Kentucky 1115 Waiver (July 2016)
  • Comments and letters from national organizations regarding Kentucky’s waiver may be found here.

Louisiana

Approved

Healthy Louisiana OUD/SUD Demonstration

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State resources
  • Federal Approval

Maine

Approved

Maine Section 1115 Demonstration for Individuals Living with HIV/AIDS 

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees, and certain people living with HIV who are not otherwise eligible for Medicaid.
  • PLWH with incomes at or below 133% FPL who are eligible for Medicaid receive Medicaid state plan-covered services and case management services.
  • PLWH with incomes at or below 250% FPL who are not otherwise eligible for Medicaid receive a targeted essential set of services. The benefits provided to this group are not recognized as Minimum Essential Coverage under the ACA.
  • State Resources
  • Federal Approval

Maine Substance Use Disorder Care Initiative

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

MaineCare

  • Status: Withdrawn
  • UPDATE—January 2019: The state withdrew its application, which would have imposed work requirements, premiums (with exemptions for enrollees in the HIV/AIDS waiver), copayments for non-emergency use of the ER, and asset tests. The proposal would also have eliminated retroactive eligibility and hospital presumptive eligibility.
  • Comments and letters from national organizations regarding Maine’s waiver may be found here.
  •  

Marshall Islands

No Waiver

Maryland

Pending

Maryland Health Choice

  • Status: Renewal Pending
  • Demonstration populations: Most Medicaid enrollees, and other select populations.
  • Authorizes a pilot program to integrate physical and behavioral health services in primary care settings for a limited number of beneficiaries.
  • Authorizes SUD treatment services for residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed renewal would authorize mental health treatment services for residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Application (Renewal, July 2021)
  • Federal Approval
  • NHeLP Comments on Maryland 1115 Request to Waive IMD Exclusion for Mental Health (August 2021)

 

Massachusetts

Pending

MassHealth 

  • Status: Amendments Pending
  • Demonstration populations: All Medicaid enrollees, and other select populations.
  • Shifts certain Medicaid populations into 1115 demonstration, including PLWH with income at or below 200% FPL.
  • Expands eligibility, with some limits on benefits, for PLWH with incomes between 133 and 200% FPL who would be eligible for Medicaid expansion but for their income. Enrollees may choose to receive premium assistance for ESI (with wraparound) in lieu of direct coverage.
  • PLWH with income above 133% FPL do not receive EPSDT services or non-emergency medical transportation, and may be subject to waiting list.
  • Discontinues provisional eligibility for certain adults. PLWH with incomes at or below 200% FPL may self-attest to income eligibility and receive 90-day provisional eligibility.
  • 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.
  • Provides subsidies for individuals under 300% FPL who are not eligible for Medicaid and who purchase Marketplace coverage.
  • Allows the state to consider family income and resources “not actually made available to the applicant,” as well as income from any member of the “family unit,” when determining income for eligibility purposes.
  • Limits retroactive eligibility to 10 days prior to application date for most eligibility groups.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • Proposed amendment seeks partial expansion to 100% FPL, and would shift coverage for ACA expansion adults and non-disabled parents and caretakers to subsidized Exchange plans (>100% FPL) or 1115 demonstration (<100% FPL) depending on income. PLWH who were eligible for MassHealth prior to ACA would remain eligible for Medicaid.
  • Proposed amendment would eliminate emergency Medicaid for immigrants who are eligible for subsidized coverage with a $0 premium and nominal cost-sharing through the Exchange.
  • Proposed amendment would implement cost-sharing limit (5% of aggregate household income) on an annual basis rather than a quarterly or monthly basis.
  • Proposed amendment would eliminate non-emergency medical transportation, except to SUD treatment services.
  • Proposed amendment would expand existing authority for mental health and SUD services delivered in IMDs to include medically necessary treatment for co-occurring mental health conditions.
  • Proposed amendment would expand existing authority for behavioral health and SUD services delivered in IMDs to improve care for adults with serious mental illness and children with serious emotional disturbance.
  • Proposed amendment would extend postpartum coverage to 12 months for enrollees with income up to 200% FPL, regardless of immigration status. Effective April 2022, citizens and lawfully residing immigrants will receive 12 months of postpartum coverage under the state plan option authorized by the American Rescue Plan Act.
  • Proposed amendment would increase income limits for Medicare Savings Programs.
  • Proposed amendment would enhance community supports for individuals in the community with justice-involvement.
  • REJECTED: CMS rejected the state’s request to impose a closed formulary.
  • State Resources
  • Federal Approval
  • Federal Application (Postpartum Coverage, Medicare Savings Programs, Justice-Involvement Amendment, June 2021)
  • Federal Application (SMI-SED Amendment, August 2020)
  • Federal Application (September 2017)
  • NHeLP Comments on Massachusetts 1115 Waiver Amendments (October 2017)
  • Comments and letters from national organizations regarding Massachusetts’ waiver may be found here.

Massachusetts COVID-19 Public Health Emergency (PHE) Demonstration

  • Status: Approved
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • Federal Approval

Michigan

Approved

Healthy Michigan 

  • Status: Approved
  • Imposes cost-sharing requirements. Cost-sharing rules depend on the enrollee’s income and how long they have been enrolled. Cost-sharing amounts are based on the enrollee’s utilization during the first 6 months of enrollment, and are billed to the enrollee on a quarterly basis.
  • Imposes monthly premiums for enrollees with incomes above 100% FPL in the form of contributions to MI Health Account. Premiums will not exceed 2 percent of income during the first 48 months of cumulative enrollment, and may be reduced through completion of healthy behavior incentives. Failure to pay premiums during the first 48 months of cumulative enrollment will not result in disenrollment. Premiums will increase to 5 percent of income after 48 months of cumulative enrollment, in lieu of cost-sharing, and may no longer be reduced through completion of healthy behavior incentives. Additionally, enrollees with incomes above 100% FPL who have had more than 48 months of cumulative enrollment will be disenrolled with lockout for failure to pay premiums; re-enrollment is contingent upon payment of past due premiums. The state has postponed implementation of premiums and healthy behavior incentives. Medically frail, including people living with HIV, are exempt from premiums.
  • Provides “healthy behavior” incentives to offset cost-sharing and monthly premiums. Enrollees with income above 100% FPL and more than 48 months of cumulative enrollment are not eligible for healthy behavior incentives. The state has postponed implementation of healthy behavior requirements. Medically frail, including people living with HIV, are exempt from the 48-month cumulative enrollment provisions.
  • Requires compliance with “healthy behaviors” or completion of a health risk assessment as a condition of eligibility for individuals with income above 100% FPL who have had at least 48 months of cumulative enrollment, with disenrollment for failure to comply. Re-enrollment is contingent upon completion of a health risk assessment. The state has postponed implementation of healthy behavior requirements. Medically frail, including people living with HIV, are exempt from the 48-month cumulative enrollment provisions.
  • Allows requests for prior authorization for prescription drugs to be addressed within 72 hours for individuals enrolled in Marketplace premium assistance. A 72-hour supply must still be provided in the event of emergency.
  • Eliminates cost-sharing for drugs related to treatment of HIV and substance use disorder.
  • Eliminates cost-sharing for services related to chronic conditions, including HIV, substance use disorder, and viral hepatitis.
  • HIV is included in the medically frail condition list. Medically frail are exempt from premiums and the 48-month cumulative enrollment provisions.
  • UPDATE—April 6, 2021: CMS has withdrawn its prior approval of Michigan’s work requirements. CMS previously senta letter to the state, to which the state did not respond, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • UPDATE—March 4, 2020: Michigan’s work requirements have been invalidated following a lawsuit in federal court. The court is still considering the legality of new premiums and copays under the waiver.
  • State Resources
  • Federal Approval
  • Comments and letters from national organizations regarding Michigan’s waiver may be found here.

Michigan 1115 Pathway to Integration

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Minnesota

Approved

Minnesota Substance Use Disorder System Reform

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes intensive outpatient SUD services not otherwise covered under the state plan.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Mississippi

Pending

Mississippi Medicaid Workforce Training Initiative

Missouri

Approved

Missouri Targeted Benefits for Pregnant Women Section 1115 Demonstration

  • Status: Approved
  • Demonstration populations: Enrollees in any Medicaid eligibility group whose 60-day postpartum period is ending and who are not otherwise eligible for Medicaid coverage that provides comparable SUD and mental health benefits.
  • Authorizes limited SUD and mental health services, including non-emergency medical transportation to and from treatment, for enrollees up to 201% FPL with an SUD diagnosis who were previously enrolled in pregnancy-related Medicaid. Postpartum coverage for these limited benefits is extended from 60 days to 10 months.
  • State Resources
  • Federal Approval

 Missouri Gateway to Better Health

  • Status: Approved
  • Demonstration populations: Uninsured adults age 19-64 who reside in the St. Louis region, have income at or below 100% FPL, and are not otherwise eligible for Medicaid.
  • Authorizes limited outpatient SUD services.
  • Clarifies that the Medicaid rebate requirements of Section 1927 do not apply to the limited prescription drug benefit provided under Gateway to Better Health.
  • State Resources
  • Federal Approval

Montana

Pending

Montana Health and Economic Livelihood Partnership (HELP) 

  • Status: Amendments Pending
  • Demonstration populations: Medicaid expansion adults.
  • Authorizes 12 months of continuous eligibility.
  • Imposes premiums for individuals with income 50-133% FPL. Individuals with income above 100% FPL may be disenrolled for failure to pay premiums, with lockout until the end of the calendar quarter or upon payment of outstanding premiums. Medically frail are exempt from premiums.
  • Uses an Alternative Benefit Plan with defined provider network.
  • Proposed amendment would impose work requirements for adults age 19-55, with disenrollment and six-month lockout for failure to comply. Medically frail would be exempt from work requirements.
  • Proposed amendment would gradually increase premiums based on the length of time an enrollee is enrolled in the program, capped at four percent of aggregate household income. Medically frail would be exempt from premiums.
  • Proposed amendment would eliminate continuous eligibility.
  • State Resources
  • Federal Approval
  • Federal Temporary Extension Approval (December 2020)
  • Federal Application (Continuous Eligibility Amendment, September 2021)
  • Federal Application (Work Requirements and Premium Increase Structure Amendment, August 2019)
  • Comments and letters from national organizations regarding Montana’s waiver may be found here.

Montana Waiver for Additional Services and Populations (WASP)

  • Status: Amendment Pending
  • Demonstration populations: Parents and Caretaker Relatives who would be ineligible is subject to redetermination prior to the end of 12 months of continuous enrollment, certain adults age 18 or older who have been diagnosed with a SDMI.
  • Authorizes 12 months of continuous eligibility.
  • Provides full Medicaid benefits to individuals age 18 or older who have been diagnosed with a SDMI and who have income above 133% FPL up to and including 150% FPL, or are eligible for Medicare and have income up to and including 133% FPL.
  • Proposed amendment would eliminate continuous eligibility for Parents and Caretaker Relatives. This effectively removes this demonstration population from the waiver altogether, since continuous eligibility is the only benefit provided.
  • Proposed amendment would eliminate cost-sharing and copayments.
  • State Resources
  • Federal Approval

 Montana Healing and Ending Addiction through Recovery and Treatment (HEART)

  • Status: Pending
  • Demonstration populations: All children age 18-20 and adults eligible for full Medicaid benefits.
  • Proposal would cover targeted services (including care management, consultations, and medications) for enrollees with SUD, SMI, or SED who are incarcerated in state prisons with 30 days prior to release.
  • Proposal would authorize SUD and mental health treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposal would authorize community-based early intervention programs that address mental health and SUD.
  • Proposal would authorize crisis intervention services.
  • Proposal would authorize expanded tenancy supports for individuals with SUD and SMI/SED.
  • State Resources
  • Federal Application

Nebraska

Approved

Nebraska Substance Use Disorder Section 1115 Demonstration

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Nebraska Heritage Health Adult 1115 Demonstration

  • Status: Withdrawn
  • UPDATE—September 2021: CMS has approved the state’s request to terminate its previously approved waiver, which would have implemented a tiered benefit system with enhanced benefits for enrollees who comply with work requirements, healthy behaviors, and personal responsibility activities. CMS previously senta letter to the state, to which the state responded, explaining that it had begun the process of determining whether to withdraw the state's previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • UPDATE—June 1, 2021: Nebraska announced that it plans to withdraw its waiver. Effective October 1, 2021, all expansion adults will receive the same benefits, which will include vision, dental, and over-the-counter medication. There was litigation pending on the state’s waiver after a lawsuit was filed in February 2021.
  • State Resources
  • Comments and letters from national organizations regarding Nebraska’s waiver may be found here. 

Nevada

No Waiver

New Hampshire

Pending

New Hampshire Granite Advantage Health Care Program

  • Status: Approved
  • Demonstration populations: Medicaid expansion adults.
  • Eliminates retroactive coverage. Although New Hampshire passed legislation in 2019 requiring the state to revise its retroactive coverage waiver and CMS has notified the state that it must reinstate three-month retroactive eligibility, this waiver provision is included in the most recent federal approval (March 2021).
  • UPDATE—March 17, 2021: CMS has withdrawn its prior approval of New Hampshire’s work requirements. CMS previously senta letter to the state, to which the state did not respond, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • UPDATE—August 19, 2019: CMS notified New Hampshire that the state must cease implementation of work requirements and reinstate three-month retroactive eligibility.
  • UPDATE—July 29, 2019: New Hampshire’s November 30, 2018 waiver approval has been invalidated following a lawsuit in federal court, on the grounds that HHS violated federal law when it approved the waiver without considering the potential coverage losses or whether the waiver furthered the objectives of the Medicaid program.
  • UPDATE—July 8, 2019: New Hampshire passed legislation providing for suspension of work requirements under certain circumstances. The administration suspended implementation through September 30, 2019 upon finding that 17,000 Medicaid members failed to report compliance with work requirements for June 2019. The legislation also requires the state to submit a revised waiver permitting 45 days of retroactive coverage.
  • State Resources
  • Federal Approval
  • Comments and letters from national organizations regarding New Hampshire’s waiver may be found here.

New Hampshire SUD Treatment and Recovery Access

  • Status: Amendment Pending
  • Demonstration populations: Adults age 21-64 eligible for full Medicaid benefits.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed amendment would authorize mental health treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • Federal Application (September 2021)

New Hampshire COVID-19 Public Health Emergency (PHE) Demonstration

New Jersey

Approved

New Jersey FamilyCare Comprehensive Demonstration

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees and other select populations.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • Extends postpartum coverage from 60 days to 12 months for enrollees with income up to 205% FPL, with continuous eligibility throughout the postpartum period. The state may begin providing extended postpartum coverage as of October 28, 2021; however, extended postpartum coverage for “lawfully residing” immigrant pregnant persons will start on April 1, 2022 under the state plan option authorized by the American Rescue Plan Act.
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • State Resources
  • Federal Approval
  • Comments and letters from national organizations regarding New Jersey’s waiver may be found here.

 

New Mexico

Pending

Centennial Care 2.0

  • Status: Amendment Pending
  • Demonstration population: All Medicaid enrollees and other select populations.
  • Access to expanded benefits for individuals who complete “healthy behaviors.”
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • The state has received approvals for a number of amendments in order to respond to the COVID-19 pandemic.
  • In February 2020, CMS approved the state’s request to remove the following previously approved waivers: premiums, copayments for non-emergency use of the hospital emergency department and non-preferred prescription drugs, and elimination of retroactive eligibility.
  • Proposed amendment would authorize mental health treatment services for short-tern residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • Federal Application (SMI Amendment, March 2021)
  • NHeLP Comments on New Mexico 1115 Waiver Behavioral Health amendment (April 2021)
  • Comments and letters from national organizations regarding New Mexico’s waiver may be found here.

New York

Pending

New York Medicaid Redesign Team 

  • Status: Renewal and Amendments Pending
  • Demonstration population: All Medicaid enrollees and other select populations.
  • Implements capitated HIV Special Needs Plans (HIV SNP) for PLWH, transgender individuals, and people experiencing homelessness. Dependent children of eligible enrollees may also enroll in a SNP plan.
  • Implements Medicaid Managed Care Health and Recovery Plans (HARPs) to integrate physical health, behavioral health, and behavioral health home and community-based services for enrollees with diagnosed severe mental illness (SMI) and/or substance use disorders (SUD).
  • HIV SNPs provide behavioral health home and community-based services to enrollees meeting HARP targeting, risk, and needs-based criteria.
  • Authorizes a Behavioral Health Self-Direction Pilot to make self-direction services available to HARP and HIV SNP enrollees receiving behavioral health home and community-based services.
  • Waives non-drug cost-sharing for certain enrollees.
  • State Resources
  • State Resources (HIV SNPs)
  • State Resources (HARPs)
  • State Resources (HARPs)
  • Federal Approval
  • Federal Application (CBLTC Amendment, March 2021)
  • Federal Application (Extension Request, March 2021)
  • Federal Application (Managed Long-Term Care Amendment, November 2020)

 

North Carolina

Approved

North Carolina's Medicaid Reform Demonstration 

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees, with exceptions. However, SUD treatment services in IMDs are available to all Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • REJECTED: CMS rejected the state’s proposals to impose premiums and work requirements on expansion group adults, on the grounds that the state currently lacks legislative approval to provide coverage to this group.
  • State Resources
  • Federal Approval
  • Duke Health Justice Clinic and North Carolina AIDS Action Network (NCAAN) Comments on North Carolina 1115 Waiver (April 2016)
  • Comments and letters from national organizations regarding North Carolina’s waiver may be found here.

North Carolina COVID-19 Public Health Emergency Demonstration

  • Status: Approved
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • Federal Approval

 

North Dakota

No Waiver

Northern Mariana Islands

No Waiver

Ohio

Pending

Ohio Section 1115 Demonstration Waiver for Substance Use Disorder Treatment

  • Status: Amendment Pending
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • Federal Application (Budget Neutrality Amendment, October 2021)

Healthy Ohio Program

  • Status: Disapproved
  • CMS rejected the state’s proposal to impose premiums (with disenrollment for failure to pay and lockout until past due premiums are paid in full).
  • Federal rejection letter (September 2016)
  • Federal application (June 2016)

 Ohio Group VIII Work Requirements and Community Engagement Section 1115 Demonstration Waiver

  • Status: Withdrawn
  • UPDATE—August 10, 2021: CMS has withdrawn its prior approval of Ohio’s work requirements (and has withdrawn its approval of the waiver as a whole because it does not include any other authorities). CMS previously sent a letter to the state, to which the state responded, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • State Resources
  • HIV Health Care Access Working Group Comments on Ohio 1115 Waiver (June 2018)
  • Comments and letters from national organizations regarding Ohio’s waiver may be found here.

Oklahoma

Pending

Oklahoma SoonerCare 

  • Status: Amendments Pending
  • Demonstration populations: Select eligibility groups, including but not limited to pregnant persons, certain children, Parents and Caretaker Relatives, and SSI recipients.
  • SoonerCare Choice program: primary care case management delivery system with patient-centered medical home (PCMH) model. The state withdrew its proposal to add Medicaid expansion population to the PCMH service delivery mode.
  • Insure Oklahoma: premium assistance program (including Employer-Sponsored Insurance program and Individual Program) for individuals who do not qualify for SoonerCare or SoonerCare Choice.
  • Eliminates retroactive coverage. Certain eligibility groups are exempt, including but not limited to pregnant persons, persons within the 60-day postpartum period, certain children, and certain seniors and people living with disabilities.
  • Eliminates EPSDT for full-time college students age 19-22 with incomes at or below 200% FPL who receive benefits through Insure Oklahoma.
  • Eliminates non-emergency transportation for Insure Oklahoma enrollees.
  • Proposed amendment would impose work requirements for adults age 19-50, with disenrollment for failure to comply and lockout until compliance is achieved.
  • Proposed amendment seeks to phase-out the Insure Oklahoma Individual Program and establish to a new income band for the Insure Oklahoma Employer-Sponsored Insurance plan of 134%-200% FPL.
  • Proposed SoonerSelect amendment would require enrollment in the waiver for all Medicaid expansion adults.
  • Proposed SoonerSelect amendment would eliminate retroactive eligibility for most adults.
  • State Resources
  • Federal Approval
  • Federal Application (SoonerSelect Amendment, February 2021)
  • Federal Application (Insure Oklahoma Amendment, November 2020)
  • Federal Application (Work Requirements Amendment, December 2018)
  • Comments and letters from national organizations regarding Oklahoma’s waiver may be found here.

 Oklahoma Institutions for Mental Disease Waiver for Serious Mental Illness/Substance Use Disorder

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD and mental health treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

 Oklahoma SoonerCare 2.0

  • Status: Withdrawn
  • UPDATE—August 2020: The state withdrew its application, which would have imposed work requirements, premiums (with exemptions for people living with HIV, SUD, or a serious mental illness), waiting periods, and lockout periods; reduced EPSDT benefits; eliminated non-emergency medical transportation, retroactive eligibility, and hospital presumptive eligibility; and authorized capped “block grant” funding.
  • Comments and letters from national organizations regarding Oklahoma’s waiver may be found here.

 

Oregon

Approved

Oregon Health Plan

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Eliminates EPSDT for children over age one, except for enrollees in the Medicaid expansion group, unless provision of EPSDT is consistent with the state’s Prioritized List of Health Services.
  • Eliminates retroactive coverage, except for Aged, Blind, and Disabled eligibility group.
  • Authorizes “HIV Community Services” program to provide specific services for PLWH, including case management and support services (case managed treatment and support plan).
  • Authorizes “HIV, Sexually Transmitted Disease, Tuberculosis” (HST) program to work with local health authorities and community-based organizations to provide guidance on delivery of services to populations impacted by HIV, STD, and TB.
  • Authorizes “Sexually Transmitted Disease” program to provide clinical training about HIV and other STDs for the clinician workforce in Oregon.
  • State Resources
  • Federal Approval

 Oregon Health Plan Substance Use Disorder 1115 Demonstration

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • State Resources
  • Federal Approval

Palau

No Waiver

Pennsylvania

Approved

Pennsylvania Medicaid Coverage Former Foster Care Youth From a Different State & SUD Demonstration

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Puerto Rico

No Waiver

Rhode Island

Approved

Rhode Island Comprehensive Demonstration

  • Status: Approved
  • Demonstration populations: Select populations that meet eligibility criteria, including but not limited to low-income pregnant persons, low-income parents, children with special needs, seniors, adults and children with behavioral health needs, people living with HIV, and persons with disabilities.
  • Expands Medicaid benefits for specific populations, including a limited benefits package of supplemental services for PLWH with incomes above 133% FPL and below 200% FPL who are ineligible for Medicaid.
  • Eliminates retroactive eligibility for most demonstration populations.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.

Rhode Island COVID-19 Public Health Emergency Demonstration (PHE)

  • Status: Approved
  • The state has received approval for an amendment in order to respond to the COVID-19 pandemic.
  • Federal Approval

South Carolina

Approved

South Carolina Palmetto Pathways to Independence

  • Status: Approved
  • Demonstration populations: Individuals with incomes up to 100% FPL who otherwise meet eligibility criteria for the Parents and Caretaker Relatives group, and “Targeted Adults” who are not otherwise eligible for Medicaid (“chronically homeless” individuals with incomes up to 5% FPL, individuals with justice-involvement in need of substance use or mental health treatment with incomes up to 100% FPL, and individuals in need of substance use treatment with incomes up to 100% FPL).
  • Provides Medicaid coverage for individuals with incomes from 62% to 100% FPL who meet all other criteria for the Parents and Other Caretaker Relatives eligibility group.
  • Provides coverage to “Targeted Adults.” Enrollment for Targeted Adults is limited to 12 months, unless the enrollee continues to be actively engaged in SUD treatment at the end of the 12-month period. The state may cap enrollment in this group.
  • Sets aside 500 slots within the “Targeted Adult” group for pregnant or postpartum individuals with income up to 194% FPL and a diagnosis of SUD and/or serious mental illness.
  • Sets aside 500 slots within the “Targeted Adult” group for parents of foster children with income up to 133% FPL who are completing or complying with an SUD treatment program as part of a family reunification plan.
  • UPDATE—August 10, 2021: CMS has withdrawn its prior approval of South Carolina’s work requirements. CMS previously sent a letter to the state, to which the state responded, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • State Resources
  • Federal Approval
  • Comments and letters from national organizations regarding South Carolina’s waiver may be found here.

South Carolina Healthy Connections Works

  • Status: Withdrawn
  • UPDATE—August 2021: CMS has withdrawn its prior approval of South Carolina’s work requirements (and has withdrawn its approval of the waiver as a whole because it does not include any other authorities). CMS previously sent a letter to the state, to which the state responded, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • State Resources
  • Comments and letters from national organizations regarding South Carolina’s waiver may be found here.

 

South Dakota

Pending

South Dakota Career Connector

  • Status: Pending
  • Demonstration populations: Adults age 19-59 enrolled in the Parent and Caretaker Relatives group and residing in Minnehaha or Pennington County.
  • Proposal would impose work requirements as a condition of eligibility for adults age 19-59 in the low-income parents and caretakers and Transitional Medical Assistance (TMA) eligibility groups in two counties. Individuals who fail to meet work requirements will be disenrolled. Medically frail, defined as “individuals unable to work due to cancer or other serious or terminal illness,” would be exempt from work requirements.
  • Proposal would implement premium assistance model for purchase of Qualified Health Plans for one additional year of Transitional Medical Assistance (TMA) coverage after expiration of original TMA period.
  • State Resources
  • Federal Application (August 2018)
  • Comments and letters from national organizations regarding South Dakota’s waiver may be found here.

Tennessee

Pending

TennCare III (Subsumes TennCare II)

  • Status: Amendments Pending
  • Demonstration populations: All Medicaid enrollees, with exceptions.
  • Approves TennCare III for 10 years. The state had requested a permanent implementation of the demonstration, which CMS did not approve.
  • Authorizes capped “block grant” funding. If the state spends less than the aggregate cap, they can retain up to 55% of the excess federal funds and spend them on non-Medicaid health programs.
  • Authorizes the state to implement a closed drug formulary. The state will only have to offer one drug per therapeutic class but will still receive statutory drug rebates.
  • Beneficiaries enrolled in the state’s patient-centered medical home (PCMH) are eligible for Medication Therapy Management (MTM).
  • Eliminates retroactive coverage for non-pregnant adults.
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • Proposed amendment would impose work requirements as a condition of eligibility for low-income parents and caretakers ages 19-64. Medically frail would be exempt from work requirements.
  • Proposed amendment would authorize the state to waive certain federal managed care regulations.
  • UPDATE—July 15, 2021: The state has withdrawn its proposal to authorize SUD treatment services for short-term residents in residential and inpatient settings that qualify as an IMD.
  • State Resources
  • Federal Approval
  • Federal Application (Care Integration Amendment, March 2021)
  • Federal Application (Work Requirements Amendment, December 2018)
  • Federal Application (Family Planning Services Amendment, August 2018)
  • Tennessee Justice Center Fact Sheet on the TennCare Block Grant
  • Comments and letters from national organizations regarding Tennessee’s waiver may be found here.

Texas

Pending

Texas Healthcare Transformation and Quality Improvement Program

  • Status: Renewal and Amendment Pending
  • Demonstration populations: All Medicaid enrollees, with exceptions.
  • Authorizes non-emergency medical transportation (NEMT) for through managed care for STAR, STAR+PLUS, and STAR Kids members.
  • UPDATE—November 15 2021: The state and CMS are continuing ongoing negotiations over the terms of the waiver.
  • UPDATE—August 20, 2021: A federal court issued a preliminary injunction prohibiting CMS from rescinding Texas’ previously approved 10-year waiver. CMS’ January 15, 2021 approval will remain in effect until a final ruling on the merits. In April 2021, CMS withdrew its January 15, 2021 approval of Texas’ waiver, stating that it “materially erred” in exempting the state from the federal notice and comment process and “fast-tracking” its 10-year approval of the waiver. Texas filed a lawsuit in May 2021 challenging CMS’ decision, and resubmitted a near-identical waiver extension application in July.
  • State Resources
  • Federal Approval
  • Federal Application (STAR Kids Preferred Drug List Amendment, November 2021)
  • Federal Application (Applied Behavioral Analysis Amendment, October 2021)
  • Federal Application (Resubmitted Extension Application, July 2021)
  • Federal Application (Medically Fragile Amendment, February 2021)
  • Comments and letters from national organizations regarding Texas’ waiver may be found here.

Utah

Pending

Utah Primary Care Network 

  • Status: Renewal and Amendments Pending
  • Demonstration populations: Select eligibility groups, including but not limited to Parent and Caretaker Relatives and Medicaid expansion adults.
  • Expands Medicaid to adults up to 138% FPL at the enhanced federal match rate. CMS rejected the state’s request to receive the enhanced federal match rate for partial expansion up to 100% FPL.
  • Provides full state benefits for “Targeted Adults.”
  • Eliminates retroactive coverage for certain enrollees.
  • Eliminates non-emergency medical transportation for certain enrollees.
  • Weakens EPSDT benefits for 19- and 20-year-olds.
  • Authorizes SUD and mental health treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands dental services to certain adults with income at 0% FPL who are receiving SUD treatment, and to beneficiaries who are living with a disability or blindness.
  • Authorizes clinically managed residential withdrawal management services, referred to as “social detoxification,” to Medicaid-eligible adults in Salt Lake County.
  • Proposed amendment would eliminate hospital presumptive eligibility.
  • Proposed amendment would impose premiums for enrollees with incomes above 100% FPL. The first premium payment would be due prior to the month of eligibility. Medically frail would be exempt from premiums.
  • Proposed amendment would allow the state to bypass the CMS waiver approval process and instead make certain changes through the state’s administrative rulemaking process. These changes would include waiting periods for the Medicaid expansion group (coverage would begin the month following application), elimination of retroactive eligibility for Medicaid expansion adults with incomes over 100% FPL, and changes to benefits packages for certain populations.
  • Proposed amendment would provide Medicaid coverage for individuals with justice-involvement who have a chronic physical or behavioral health condition, mental illness, or opioid use disorder in the 30-day period immediately prior to release from a correctional facility.
  • Proposed amendment would provide housing-related services and supports for certain adults experiencing chronic homelessness, justice-involvement, or SUD.
  • REJECTED: CMS rejected the state’s request to receive the enhanced federal match rate for partial expansion. The enhanced match is unavailable for waivers that limit enrollment in the new adult group, either by implementing an income cutoff of less than 138% FPL or through an enrollment cap.  
  • REJECTED: CMS rejected the state’s request to implement an enrollment cap for the expansion population.
  • UPDATE—August 10, 2021: CMS has withdrawn its prior approval of Utah’s work requirements. CMS previously senta letter to the state, to which the state responded, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • State Resources
  • Federal Approval
  • Federal Application (Extension Request, June 2021)
  • Federal Application (IVF and Genetic Testing Amendment, December 2020)
  • Federal Application (Justice-Involved Amendment, June 2020)
  • Federal Application (Fallback Plan and Housing-Related Services and Supports Amendment, November 2019)
  • NHeLP Comments on Utah 1115 Waiver Amendment (December 2019)
  • NHeLP Comments on Utah 1115 Waiver Extension Amendments (September 2017)
  • Comments and letters from national organizations regarding Utah’s waiver may be found here.

 Utah Per Capita Cap 1115 Demonstration

  • Status: Pending
  • Demonstration populations: Medicaid expansion adults with incomes at or below 95% FPL and “Targeted Adults” age 19-64 with incomes at or below 5% FPL (“chronically homeless” individuals and certain individuals in need of substance use or mental health treatment).
  • Proposal would authorize a per capita cap funding mechanism.
  • Proposal would impose work requirements for the Medicaid expansion population, with disenrollment for failure to comply and lockout until compliance is achieved.
  • Proposal would eliminate hospital presumptive eligibility for the Medicaid expansion population.
  • Proposal would authorize dental benefits for “Targeted Adults.”
  • Proposal would authorize SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposal would authorize a Clinically Managed Residential Withdrawal Pilot.
  • Proposal would weaken EPSDT benefits for 19- and 20-year-olds.
  • Proposal would authorize housing-related services and supports.
  • REJECTED: CMS rejected the state’s request to receive the enhanced federal match rate for partial expansion. The enhanced match is unavailable for waivers that limit enrollment in the new adult group, either by implementing an income cutoff of less than 138% FPL or through an enrollment cap. 
  • State Resources
  • Federal Application (August 2019)
  • Comments and letters from national organizations regarding Utah’s waiver may be found here.

Vermont

Pending

Vermont Global Commitment to Health 

  • Status: Renewal Pending
  • Demonstration populations: All Medicaid enrollees, and other select populations.
  • Authorizes premium subsidies for individuals enrolled in a QHP with incomes at or below 300% FPL.
  • Authorizes SUD and mental health treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • Proposed renewal would transition the state’s Medicaid program to a state-run, risk-bearing Medicaid managed care plan.
  • State Resources
  • Federal Approval
  • Federal Application (June 2021)

 

Virgin Islands

No Waiver

Virginia

Approved

Building and Transforming Coverage, Services, and Supports for a Healthier Virginia

  • Status: Approved
  • Demonstration populations: Select eligibility groups, including but not limited to Medicaid expansion adults, pregnant persons, Parents and Caretaker Relatives, and Transitional Medical Assistance.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Authorizes limited housing and employment supports to certain high needs enrollees with a behavioral health need, need for assistance with daily living, or a complex physical health need. CMS is still reviewing some aspects of the state’s proposal to provide housing supports.
  • UPDATE—July 2020: CMS approved the state’s request to remove previously approved waivers allowing premiums and work requirements.
  • State Resources
  • Federal Approval
  • Comments and letters from national organizations regarding Virginia’s waiver may be found here.

Virginia FAMIS MOMS and FAMIS Select

  • Status: Approved
  • Demonstration populations: Certain pregnant persons and children.
  • Extends CHIP coverage to uninsured pregnant persons with income at or below 200% FPL.
  • Extends postpartum coverage from 60 days to 12 months for enrollees with income up to 205% FPL, with continuous eligibility throughout the postpartum period. The state may begin providing extended postpartum coverage as of November 18, 2021 through June 30, 2029; however, extended postpartum coverage for “lawfully residing” immigrant pregnant persons will start on April 1, 2022 and end on March 31, 2027 under the state plan option authorized by the American Rescue Plan Act.
  • State Resources (FAMIS MOMS)
  • State Resources (FAMIS Select)
  • Federal Approval
  • Comments and letters from national organizations regarding Virginia’s waiver may be found here.

Washington

Pending

Washington Medicaid Transformation Project

  • Status: Amendment and Renewal Pending
  • Demonstration populations: All Medicaid enrollees and certain older adults.
  • 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.
  • Authorizes SUD and mental health treatment services and mental health services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • State Resources
  • Federal Approval
  • Federal Application (Amendment Request, January 2021)
  • Federal Application (Renewal Request, December 2020)

Washington COVID-19 Public Health Emergency

  • Status: Approved
  • The state has received approval for a number of amendments in order to respond to the COVID-19 pandemic.
  • Federal Approval

 

District of Columbia

Approved

D.C Behavioral Health Transformation

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD and mental health treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Expands community-based behavioral health benefits.
  • State Resources
  • Federal Approval

West Virginia

Approved

West Virginia Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorder 

  • Status: Approved
  • Demonstration populations: All Medicaid enrollees.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • State Resources
  • Federal Approval

Wisconsin

Pending

Wisconsin BadgerCare Reform 

  • Status: Amendment Pending
  • Authorizes state to implement partial expansion by providing benefits to non-pregnant childless adults ages 19-64 with incomes at or below 100% FPL. “Childless” adults may have children, but do not live with children under age 19.
  • Imposes premiums for childless adults with incomes above 50% FPL, with disenrollment and 6-month lockout for failure to comply; early re-enrollment permitted upon payment of past due premiums. Premiums may be reduced for individuals who do not engage in “health risk behaviors,” including alcohol consumption and illicit drug use.
  • Imposes premiums for Transitional Medical Assistance (TMA) enrollees with incomes above 133% FPL, with disenrollment and 3-month lockout for failure to comply. The 3-month lockout does not extend the 12-month TMA eligibility period.
  • Requires completion of health risk assessment as a condition of eligibility.
  • Authorizes SUD treatment services for short-term residents in residential and inpatient treatment settings that qualify as an IMD.
  • Proposed amendment would establish Health Savings Accounts for individuals paying premiums.
  • UPDATE—April 6, 2021: CMS has withdrawn its prior approval of Wisconsin’s work requirements. CMS previously senta letter to the state, to which the state did not respond, explaining that it had begun the process of determining whether to withdraw the state’s previously approved authorities after making the preliminary decision that work requirements do not promote the objectives of Medicaid.
  • State Resources
  • Federal Approval
  • Federal Application (December 2020)
  • Comments and letters from national organizations regarding Wisconsin’s waiver may be found here.

 Wisconsin Senior Care 

  • Status: Amendment Pending
  • Demonstration populations: Individuals age 65 or older who are not eligible for full Medicaid benefits or low-income Medicare beneficiary programs.
  • Provides comprehensive prescription drug benefits to Wisconsin residents age 65+ with income at or below 200% FPL who are not otherwise eligible to receive full Medicaid benefits.
  • Proposed amendment would authorize coverage of vaccinations.
  • State Resources
  • Federal Approval
  • Federal Application (November 2020)

 

Wyoming

No Waiver

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 
  • Impose additional eligibility requirements, such as work requirements, increased cost-sharing, monthly premiums, and lifetime enrollment caps
  • Expand eligibility for family planning services, for instance, by increasing the income threshold or not limiting eligibility to women

How Do Medicaid 1115 Waivers Impact HIV and Hepatitis 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 opposed to through the traditional Medicaid fee-for-service or managed care systems)

What Other Resources Are There on 1115 Waivers?