This page tracks approved and pending Section 1115 Medicaid demonstration waivers, which provide states a means to test new approaches in Medicaid that differ from what is required under federal law. Key themes of currently approved and pending waivers include targeted expansion of eligibility, expansion of benefits (particularly in the behavioral health area, such as coverage of services provided in IMDs), and related provisions to the social determinants of health. States can obtain “comprehensive” Section 1115 waivers that make significant changes to Medicaid eligibility, benefits, provider payments, and other rules in their programs; other exemptions may be more narrow and address specific populations or benefits.
Exemptions under section 1115 generally reflect priorities identified by states and the federal Centers for Medicare and Medicaid Services (CMS), as well as changing priorities from one presidential administration to the next. Especially:
- Beginning in the 1990s, waiver activities increased and their scope expanded. In the past, under different administrations, waivers have been used to expand coverage, modify delivery systems, and restructure funding and other program elements.
- The Trump administration Section 1115 Waiver Policy underlines work requirements and other eligibility restrictions, payment for institutional behavioral health services, and capped funding.
- The Biden administration has signaled a policy change emphasize waivers that expand, rather than restrict, Medicaid coverage and access to care (although always within the bounds of budget neutrality). The Biden administration has withdrawn approvals of work requirements (these are reflected on the Job Requirements Tab) and started to disappear premium requirementsand instead encouraged states should propose innovative waivers to Section 1115 that expand coverage, reduce health disparities, and/or advance care of the whole person (including addressing health-related social needs).
This page tracks approved and pending Section 1115 waiver provisions (including expansions and restrictions) related to eligibility, benefits, and social determinants of health and other delivery system reforms, a once these exemptions are published on the List of state waivers on Medicaid.gov. This information is contained in the following tables:
Detailed thematic tables
Aggregated status tables
For more information on the inclusion criteria and each provision, as well as a list of acronyms, see Definitions tab.
