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Leveraging Section 1115 Demonstrations to Drive Equity in Medicaid

In a new white paper, America’s Essential Hospitals discusses leveraging Section 1115 demonstrations to drive equity in Medicaid and provides recommendations to prioritize equity in waiver policy.

In fall 2021, Centers for Medicare & Medicaid Services (CMS) leadership developed Section 1115 waiver principles to support equity in federal Medicaid policies. With CMS’ renewed commitment to health equity, the agency should promote equity by developing and implementing policies that reduce disparities and making equity a routine component in waiver approval and evaluation processes.

In the white paper, the association recommends:

  • approving equity-targeted Section 1115 waivers to expand coverage to cover populations, services, and providers that would not otherwise be covered;
  • establishing social determinants of health incentive payment programs; and
  • mitigating workforce challenges through waiver-based workforce programs.

Other recommendations include integrating equity into all waiver programming and ensuring budget neutrality policies allow for equity initiatives.

This white paper is the second in a series highlighting ways the Medicaid program can be leveraged to mitigate health inequities in the United States. The first white paper in this series, Structural Racism and Chronic Underfunding of Medicaid, discusses the chronic underfunding of Medicaid as a form of structural racism and provides recommendations to ensure the programs is an effective tool to improve equity.

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About the Author

Julie Kozminski is a senior policy analyst at America's Essential Hospitals.

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