Section 1115 Demonstrations

About Section 1115 Demonstrations

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs. The purpose of these demonstrations, which give states additional flexibility to design and improve their programs, is to demonstrate and evaluate policy approaches such as:

  • Expanding eligibility to individuals who are not otherwise Medicaid or CHIP eligible;
  • Providing services not typically covered by Medicaid; or
  • Using innovative service delivery systems that improve care, increase efficiency, and reduce costs.

There are general criteria CMS uses to determine whether Medicaid/CHIP program objectives are met. These criteria include whether the demonstration will:

  1. increase and strengthen overall coverage of low-income individuals in the state;
  2. increase access to, stabilize, and strengthen providers and provider networks available to serve Medicaid and low-income populations in the state;
  3. improve health outcomes for Medicaid and other low-income populations in the state; or
  4. increase the efficiency and quality of care for Medicaid and other low-income populations through initiatives to transform service delivery networks.

Demonstrations must also be "budget neutral" to the Federal government, which means that during the course of the project Federal Medicaid expenditures will not be more than Federal spending without the waiver.

Generally, section 1115 demonstrations are approved for an initial five-year period and can be extended for an additional three years. States commonly request and receive additional 3-year extension approvals. Certain demonstrations that have had at least one full extension cycle without substantial program changes will be eligible for CMS’ “fast track” review process for demonstration extensions. For more information on the fast track federal review process for section 1115 Medicaid and CHIP demonstration extensions, visit the How States Apply page.

Final Rule-Review and Approval Process for Medicaid and CHIP Section 1115 Demonstrations

Section 1115 Demonstration Transparency State Health Official Letter

In September 2014, the Centers for Medicare & Medicaid Services (CMCS) initiated a national, cross-state evaluation of four types of Medicaid section 1115 demonstrations. See the evaluation design.

In October 2015, CMCS released the first report to Congress, as required by the Affordable Care Act, on actions taken with respect to demonstration projects submitted under section 1115(a) of the Social Security Act. This first report to Congress provides a comprehensive history of federal public notice and comment policies applied to state Medicaid and CHIP demonstration projects and highlights federal transparency actions taken on state applications for 1115 demonstrations through September 2015. See the report to Congress.

Note: This website provides policy information and data on demonstration projects in participating States.

If you are looking for health coverage in your State or to learn more about applying for Medicaid, please go to

Public Comments

The Affordable Care Act requires opportunity for public comment and greater transparency of the section 1115 demonstration projects. A final rule, effective on April 27, 2012, establishes a process for ensuring public input into the development and approval of new section 1115 demonstrations as well as extensions of existing demonstrations. This final rule sets standards for making information about Medicaid and CHIP demonstration applications and approved demonstration projects publicly available at the State and Federal levels. The rule ensures that the public will have an opportunity to provide comments on a demonstration while it is under review at CMS. At the same time, the final rule ensures that the development and review of demonstration applications will proceed in a timely and responsive manner.

There will be a 30-day Federal comment period for the general public and stakeholders to submit comments. CMS will not act on the demonstration request until 15 days, at a minimum, after the conclusion of the public comment period. CMS will continue to accept comments beyond the 30-day period; however, CMS cannot guarantee that comments received after the 30-day comment period will be considered due to the need for timely Federal review of a State's request. Therefore, CMS strongly encourages comments to be submitted within the 30-day Federal comment period.

Once a State’s 30-day public comment period has ended, the State will submit an application to CMS. Within 15 days of receipt of the application, CMS will determine whether the application is complete. CMS will send the State written notice informing the State of receipt of the complete application, the date on which the Secretary received the application, and the start date of the 30-day Federal public notice period. If CMS determines that the application is not complete, CMS will notify the State of any missing elements in the application.

How to Comment on Pending Demonstration Applications

To comment on a specific pending demonstration, browse the waivers list and select a specific demonstration application or search by state or program name. Follow the link to submit your comments. CMS will review and post comments received, but will not respond to each individual comment.

View Section 1115 Demonstration List

Send Feedback

CMS is continuously making efforts to improve the demonstration and public comment processes. Please send us your feedback. Email: