Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS). On March 14, 2017, the CMS sent a letter to state governors that signaled a willingness to use Section 1115 authority to support work requirements and the alignment of Medicaid programs with private insurance policies. In November 2017, the CMS posted revised criteria for Section 1115 waiver demonstrations. A number of states have waivers pending at CMS that include provisions not previously approved including work requirements, drug screening and testing, eligibility time limits, and premiums with disenrollment for non-payment for traditional Medicaid populations. Some of the requests are part of ACA expansion waivers, while others would apply to traditional populations. The map below tracks states with approved Section 1115 Medicaid waivers and pending waivers (which include new waiver applications, waiver amendments, and renewals). Use the drop down box to view approved and pending waivers according to waiver category. Related KFF waiver resources are available by topic at the bottom of this page as well as downloadable tables with additional detail on each approved and pending waiver.
Approved and Pending Section 1115 Medicaid Waivers, as of December 13, 2017
Note: Pending waivers include new applications, amendments to existing waivers, and renewal/extension requests.
Some states have multiple waivers, and many waivers are comprehensive and may fall into a few different areas. Pending waivers include new applications, amendments to existing waivers, and renewal/extension requests. State waiver renewals that do not propose changes and amendments that are technical in nature are excluded from this tracker and the accompanying tables. This map does NOT include/capture states mandating managed care through Section 1115 (since waiver authority is not generally required for these initiatives) and does not capture delivery system reform, behavioral health, or LTSS initiatives that do not require Section 1115 expenditure authority/federal funds. For additional details on what is included in each category, see category-specific notes.