Section 1115 waivers give states flexibility to design and improve their Medicaid and CHIP programs. Waivers let states test new or existing ways to deliver and pay for program coverage.
1115 Waiver Basics
Budget Neutrality Requirement
Waivers must be “budget neutral” to the federal government. The State must show that over the duration of the entire waiver, the federal Medicaid expenditures won’t exceed what the federal government would have spent without the waiver.
Approval Period
Waivers are generally approved for a five-year period, but states typically submit renewal requests to continue the program beyond this time period. Waiver renewals are generally approved for three years.
Transparency
The Affordable Care Act of 2010 requires a transparent review process for 1115 Waivers. A final rule, effective on April 27, 2012, establishes a process to ensure public input into the development, review, and approval (or extension) of 1115 Waivers. This final rule sets standards to make information about Medicaid and CHIP Demonstration applications and approved Demonstration projects publicly available at the State and Federal levels.
Final-Rule-Review and Approval Process for Medicaid and CHIP Section 1115 Demonstrations
How States Apply
There is no standard process to apply for an 1115 Waiver. States typically work with CMS to submit an informal concept paper and develop a proposal. Every waiver includes terms and conditions that outline the operation and financing of the approved demonstration project.