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Medicaid Research and Demonstration Projects Waivers - Overview

This topic provides an overview of Medicaid Research and Demonstration Projects Waivers. These are also known as 1115 waivers.

Purpose

Section 1115 of the Social Security Act provides the Secretary of Health and Human Services with broad authority to authorize experimental, pilot, or demonstration projects that, in the judgment of the Secretary, are likely to assist in promoting the objectives of the Medicaid statute.

General Features

Flexibility under section 1115 is sufficiently broad to allow States to test substantially new ideas of policy merit. States commit to a policy experiment that will be evaluated. Section 1115 should demonstrate something that has not been demonstrated on a widespread basis. The specific research and demonstration finding will be drawn from the project's results.

Eligibility And Additional Services

The authority provides flexibility, under the Secretary's discretion, for the provision of services that are not otherwise matchable. It allows for the expansion of eligibility for those who would otherwise not be eligible for the Medicaid program.

Evaluation And Reporting Requirements

Centers for Medicare and Medicaid Services (CMS) maintains the responsibility to evaluate the project. This includes: state specific and cross-state analyses of impact on utilization, insurance coverage, public and private expenditures, quality, access, and satisfaction.

Time

States can discuss potential demonstration project concepts with CMS early in the approval process. Projects are generally approved to operate for a five-year period.

Health Care Reform Demonstrations

States can expand managed care to include HMOs, partially capitated systems, primary care case managers, or other variations. Oftentimes savings are achieved from managed care arrangements and used to finance coverage to individuals previously ineligible for Medicaid.

Financial

The demonstration must be budget neutral over the life of the project (generally 5 years), and is subject to OMB, CMS, and Departmental approval. The demonstrations cannot be expected to cost the Federal government more than it would cost without the waiver.

Current Waivers

As of August 2003, 17 States had Section 1115 projects approved and implemented, and three more States had Section 1115 projects approved and pending implementation.

A current list of Comprehensive Health Care Reform Demonstrations is available at: http://www.cms.gov/medicaid/1115/statesum.pdf. This requires Adobe Acrobat Reader. The list includes, by State, all approved and implemented, approved but not-yet-implemented, terminated, and expired waivers under Section 1115.

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