Section 1115 Demonstrations

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Infographic highlighting the objectives of the section 1115 demonstration program. Providing states additional flexibility can increase quality of care by transforming delivery systems, improving health outcomes, strengthening coverage, and increasing access.

Overview

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 Children’s Health Insurance Program (CHIP) programs. Under this authority, the Secretary may waive certain provisions of the Medicaid law to give states additional flexibility to design and improve their programs. The purpose of these demonstrations 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.

States who want to request a program under this authority must submit a written application to CMS for approval that details the goals and operational aspects of the program, and those applications are subject to public review and comment.

Other waiver authorities include Section 1915(b) Freedom of Choice (Managed Care) Waivers and Section 1915(c) Home and Community-Based Services Waivers.

Policy and Program Topics

State Medicaid & CHIP Profiles