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Medicaid Section 1115 Demonstrations Rules and Comments

For more than 40 years, the Centers for Medicare & Medicaid Services (CMS) has used Section 1115 of the Social Security Act to approve “experimental, pilot, or demonstration” projects that increase the flexibility and extend the reach of Medicaid and the Children’s Health Insurance Program (CHIP). These projects give states additional authority to design and improve their program in various ways, such as expanding eligibility; providing additional services; and incentivizing innovation that improves care, increases efficiency, and reduces costs.

As states focus on transforming their delivery systems to prepare for Affordable Care Act (ACA) implementation, demonstration projects provide a platform for applying the Triple Aim—a framework developed by the Institute for Healthcare Improvement for optimizing health system performance. The Triple Aim focuses on improving the quality of patient care, increasing efficiency and reducing costs, and addressing population health.

As mandated by the ACA, CMS implements provisions that set transparency and other procedures for approving waivers under section 1115.

Final Rule

Published February 2012.

Association Comments on Proposed Rule

Submitted November 2010.

Proposed Rule

Published September 2010.

 

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