The agency encourages states to leverage a new Section 1115 demonstration to implement a service delivery system that facilitates reentry transitions for Medicaid-eligible individuals leaving prisons and jails.
view more »CMS Releases Guidance on Reentry Section 1115 Waiver Opportunity
April 18, 2023 ||A new Section 1115 demonstration will support service delivery systems that facilitate reentry transitions for Medicaid-eligible individuals leaving prisons and jails.
view more »CMS Proposes to Revise Medicare DSH Calculation
Feb. 28, 2023 ||CMS proposes to limit the types of Medicaid Section 1115 waiver days that can be included when calculating a hospital’s disproportionate patient percentage.
view more »CMS Approves Arkansas HRSN Section 1115 Waiver
Nov. 4, 2022 ||The amendment establishes "Life360 HOMEs" coordinating care for rural residents, pregnant individuals, and young adults at risk for long-term poverty.
view more »CMS Extends Arizona Section 1115 Waiver with Housing Focus
Oct. 25, 2022 ||The waiver provides temporary housing to Medicaid beneficiaries experiencing or at risk of homelessness who have a significant health need or are enrolled in long-term care.
view more »CMS Extends Two Section 1115 Waivers
Oct. 17, 2022 ||Section 1115 waivers in Massachusetts and Oregon aim to test improvements in coverage, access, and quality and target unmet health-related social needs.
view more »Leveraging Section 1115 Demonstrations to Drive Equity in Medicaid
April 29, 2022 ||In a white paper, the association encourages CMS to develop policies that reduce disparities and incorporate equity into waiver approval and evaluation processes.
view more »HHS Approves Historic Maternal Health Waiver
April 13, 2021 ||The waiver makes Illinois the first state to provide continuity of full Medicaid benefit coverage for mothers by extending eligibility during the entire first year after delivery.
view more »HHS Brief Examines Medicaid Section 1115 Policies
March 18, 2021 ||In response to an executive order, a new issue brief reviews four policy areas under Section 1115 demonstrations and their impact on Medicaid coverage and access to care. The brief notes all examined areas create barriers to enrollment and reduce coverage, leading to adverse health effects.
view more »States Respond to COVID-19: 1115 Waiver Program Enhanced Calif.’s Pandemic Response
Sept. 15, 2020 ||With community partnerships already underway through California's Whole Person Care initiative — part of its Section 1115 Medicaid waiver — localities in California found it easier to reach vulnerable communities at high risk for contracting COVID-19.
view more »GAO Report on State Medicaid Administration Challenges
June 9, 2020 ||The report, requested by Republican representatives, details challenges states face in administering Medicaid programs, including with coverage exclusions and care coordination, coverage benefits and eligibility, and Medicare and Medicaid alignment.
view more »Medicaid, CHIP Resources for COVID-19 Response
March 23, 2020 ||CMS issued several checklists and templates for state Medicaid and the Children's Health Insurance Program agencies to request regulatory relief and flexibility to respond to the COVID-19 outbreak.
view more »Okla. Releases Application for Medicaid Block Grants
March 22, 2020 ||Under the proposed Section 1115 waiver, Oklahoma would accept a per-capita cap on federal funds for the Medicaid expansion population and incorporate other market-based reforms.
view more »Court Vacates Mich. Medicaid Work Requirements
March 9, 2020 ||This decision is the latest of several court cases invalidating work requirements policies in Medicaid; Utah now is the only state with these requirements in effect. It is unknown at this time if Michigan or the Department of Health and Human Services will appeal the decision.
view more »Appeals Court Strikes Down Ark. Medicaid Work Requirements
Feb. 20, 2020 ||In the unanimous decision, the United States Court of Appeals for the District of Columbia Circuit found that the Department of Health and Human Services failed to adequately assess the potential impact of work requirements on coverage under Arkansas' Section 1115 demonstration waiver.
view more »CMS Approves Medicaid Work Requirements in S.C.
Dec. 16, 2019 ||Through this newly approved Section 1115 demonstration waiver, South Carolina becomes the first state to apply work requirements primarily to parents and caregivers.
view more »States Tackle Substance Use Disorder in Pregnant Women
Nov. 25, 2019 ||States are leveraging financial incentives, quality measures, waivers, and public-private partnerships to slow climbing rates of substance use disorder and overdose among pregnant women.
view more »GAO Report Analyzes Medicaid Work Requirement Waiver Costs
Oct. 11, 2019 ||The report includes recommendations to the Centers for Medicare & Medicaid Services for improved oversight of these waivers.
view more »Court Rejects New Hampshire Work Requirements
Aug. 5, 2019 ||The court ruled that the Secretary of Health and Human Services failed to adequately consider the effect of the work requirements on Medicaid coverage.
view more »Under five-year demonstration projects, these states are approved to receive Medicaid matching funds for treatment in facilities that qualify as institutions for mental diseases.
view more »Medicaid Policy in 2019: Social Determinants of Health
June 25, 2019 ||As essential hospitals target social determinants of health in their communities, it is crucial that the Medicaid program continues to evolve to ensure this vital work can continue.
view more »Medicaid Policy in 2019: Expansion
May 9, 2019 ||Decisions made at the state and federal levels regarding Medicaid expansion continue to evolve nearly a decade after passage of the Affordable Care Act.
view more »CMS Approves Medicaid Work Requirements, Spending Cap in Utah
April 8, 2019 ||Utah joins a growing list of states with approval to implement Medicaid work requirements, but it is the first state to limit enrollment to individuals below the federal poverty level and implement a spending cap.
view more »Court Rejects Arkansas, Kentucky Work Requirements
April 1, 2019 ||The court ruled that the Department of Health and Human Services overstepped its authority and failed to show that work requirements would help promote the purpose of the Medicaid program
view more »CMS Releases Guidance on Waiver Monitoring, Evaluation
March 18, 2019 ||The tools and guidance aim to help states monitor and evaluate the effects of Section 1115 waiver demonstrations, including those with work and community engagement requirements and those that combat substance use disorder.
view more »CMS Approves Medicaid Work Requirements in Ohio
March 18, 2019 ||Ohio’s waiver requires beneficiaries ages 18 to 49 who are eligible through Medicaid expansion to work or participate in other community engagement activities for at least 80 hours a month.
view more »Medicaid Strategies for Non-Opioid Pain Management
Feb. 25, 2019 ||A Centers for Medicare & Medicaid Services bulletin notes that states can cover non-opioid pain management therapies using several Medicaid authorities, including Section 1945 health home benefits, 1915(i) state plan amendments, Section 1115 demonstrations, and managed care strategies.
view more »CMS Approves Medicaid Work Requirements in Arizona
Jan. 22, 2019 ||The waiver requires beneficiaries ages 19 to 49 who are eligible through Medicaid expansion to work or participate in community engagement activities for at least 80 hours a month.
view more »CMS Approves Medicaid Work Requirements in Maine, Michigan
Jan. 7, 2019 ||Maine and Michigan join five other states to receive approval for Medicaid work requirements; unlike most other states, Maine's work requirements will apply to both existing beneficiaries and those newly eligible through expansion.
view more »CMS Approves N.M. IMD Exclusion Waiver
Dec. 21, 2018 ||The waiver permits federal reimbursement for short-term stays in institutions for mental disease for individuals with substance use disorders.
view more »CMS Reapproves N.H. Work Requirements
Dec. 10, 2018 ||The state’s waiver initially was approved in May, but required a second approval to extend beyond Dec. 31.
view more »CMS Reapproves Kentucky Medicaid Work Requirements
Dec. 4, 2018 ||The U.S. District Court for the District of Columbia vacated the previous approval, saying the administration failed to adequately assess the waiver's impact on Medicaid’s core objective: to provide health care coverage for beneficiaries.
view more »Medicaid Demonstration Targets Serious Mental Illness Treatment
Nov. 15, 2018 ||A new demonstration opportunity, which can be carried out through Section 1115 waivers, would allow states to receive reimbursement for services at institutions for mental disease for individuals with serious mental illness or serious emotional disturbance.
view more »CMS Approves Wisconsin Medicaid Work Requirements
Nov. 5, 2018 ||Wisconsin is the fifth state to receive approval to incorporate work and community engagement requirements as a condition of Medicaid eligibility.
view more »CMS Approves Virginia Medicaid Expansion
Oct. 23, 2018 ||The expansion is expected to give up to 400,000 additional Virginians access to the program; the Centers for Medicare & Medicaid Services has not announced a decision on the state's Section 1115 waiver, which includes work requirements.
view more »Finance and Payment Policy: 3 Key Insights from VITAL2018
Sept. 12, 2018 ||Several presentations at VITAL2018 focused on a foundational issue for essential hospitals—finance and payment policy—and provided member insights on topics such as Section 1115 Medicaid waivers, state policy trends in the 340B Drug Pricing Program, and digitizing the revenue cycle.
view more »Learn more about the Essential Hospitals Value-Based Care Collaborative and hear how Premier helped NewYork-Presbyterian Queens in the 1115 DSRIP Waiver program to bring additional value to the community.
view more »CMS Issues Guidance on 1115 Waiver Budget Neutrality
Aug. 27, 2018 ||The letter marks the first time the Centers for Medicare & Medicaid Services has clearly described its budget neutrality calculation and represents its attempts to streamline the waiver process and control costs.
view more »Hear about the state of Medicaid waivers under the Trump administration, and look ahead at the future of waiver innovations.
view more »What comes next after the June 29 court ruling that vacated the U.S. Department of Health and Human Services approval of a Section 1115 waiver that allowed Kentucky to impose community engagement and work requirements on Medicaid beneficiaries.
view more »Court Rejects Kentucky Medicaid Waiver
July 5, 2018 ||The decision strikes down the state's overall Section 1115 waiver, which included community engagement and work requirements, but it upholds as a separate waiver a portion allowing Medicaid reimbursement for substance use disorder treatment in institutions for mental disease.
view more »MACPAC Releases June Report to Congress
June 25, 2018 ||This year's Medicaid and CHIP Payment and Access Commission report focuses on the high cost of prescription drugs and the opioid epidemic.
view more »CMS Approves N.H. Medicaid Work Requirements
May 14, 2018 ||New Hampshire is the fourth state to receive approval to incorporate work and community engagement requirements as a condition of Medicaid eligibility.
view more »New Research Highlights Evolving Role of DSRIPs
April 2, 2018 ||Reports by the National Academy of State Health Policy and the Medicaid and CHIP Payment and Access Commission point to new trends, including increased focus on reform, new financing mechanisms, and standardized evaluation.
view more »Work Requirements in Medicaid Waivers
March 29, 2018 ||A new policy brief examines Centers for Medicare & Medicaid Services guidance on work and community engagement requirements for Medicaid eligibility and outlines recently approved section 1115 waivers in Kentucky, Indiana, and Arkansas.
view more »Administration Unveils Plan to Combat Opioid Crisis
March 20, 2018 ||The three-pronged approach aims to reduce drug demand, cut off the flow of illicit drugs domestically and internationally, and expand opportunities for proven addiction treatments.
view more »CMS Approves Arkansas Medicaid Work Requirements
March 6, 2018 ||Under the approved waiver, Arkansas Medicaid beneficiaries ages 19 to 49 beginning June 1 must work or participate in community engagement activities for 80 hours per month to maintain their eligibility.
view more »CMS To Host Call on 1115 Community Engagement Initiative
Jan. 12, 2018 ||The Centers for Medicare & Medicaid Services announced the community engagement initiative, often referred to as work requirements, in a Jan. 11 letter and a frequently asked questions document.
view more »CMS Approves Waiver Extensions for Texas, Mississippi
Jan. 2, 2018 ||The waiver extensions fund Texas' uncompensated care pool and delivery system reform incentive payment program and provide family planning services for low-income individuals in Mississippi for 10 years.
view more »Association Submits Response to Innovation Center New Direction
Nov. 20, 2017 ||In response to the request for information, the association encouraged flexibility and a focus on hospitals treating high numbers of complex patients.
view more »CMS to Streamline Medicaid Demonstration, Waiver Policies
Nov. 14, 2017 ||In a speech to the National Association of Medicaid Directors, Administrator Verma also announced an initiative to create scorecards for Medicaid and CHIP outcomes.
view more »CMS Announces New Opioid Policy, Approves State Demonstrations
Nov. 3, 2017 ||CMS announced a new streamlined process to encourage state innovation through demonstrations and approved new demonstrations for New Jersey and Utah.
view more »CMS Approves West Virginia Medicaid Waiver
Oct. 16, 2017 ||The five-year demonstration project, beginning Jan. 1, 2018, aims to strengthen substance use disorder care for state Medicaid beneficiaries.
view more »Explore Whole Person Care, a pilot initiative through California’s Section 1115 Medicaid waiver that works to improve care for people with complex issues by tackling medical, behavioral, and socioeconomic needs.
view more »CMS Approves Extension of Florida Medicaid Waiver
Aug. 4, 2017 ||The decision extends by five years the state's demonstration of a capitated Medicaid managed care program and a low-income pool to provide support for the safety net.
view more »CMS Outlines Section 1115 Budget Neutrality Methodology Changes
July 24, 2017 ||A publicly released set of slides describes dramatic restrictions to CMS' budget neutrality policy for Section 1115 waivers.
view more »Market-Based Approaches to Medicaid Expansion
May 15, 2017 ||In this new policy brief, America's Essential Hospitals examines Section 1115 waivers that use a market-based approach to expanding Medicaid.
view more »Price, Verma Outline Medicaid Priorities
March 17, 2017 ||The letter affirms their desire to improve the Medicaid program and the vulnerable people it serves and to ensure the program provides value to taxpayers.
view more »States Can Use Medicaid Funds To Protect Against Zika
June 7, 2016 ||A CMS bulletin reminds states that Medicaid funds can be used for prevention, diagnosis, and treatment of the Zika virus.
view more »Health Affairs Details Medicaid’s Commitment to Access and Quality
July 31, 2015 ||Articles focus on innovative waivers that support states in transforming delivery systems to improve access and quality of care. Another focus is Medicaid coverage in areas of crucial need, such as mental health care.
view more »Government Funding for Substance Abuse Treatment
July 29, 2015 ||States may apply for a Section 1115 Medicaid waiver to support innovative care delivery for substance abuse disorder. SAMHSA, HRSA to also offer funding opportunities.
view more »CMS Will Fast-Track Certain Section 1115 Waiver Renewals
July 29, 2015 ||Proposed renewals must be for demonstrations that are working effectively and have no major or complex policy changes. Certain waivers that use the enhanced FMAP are ineligible.
view more »MACPAC: DSRIPs Are Challenging But Beneficial
June 16, 2015 ||MACPAC's report to Congress touts potential of DSRIP programs to transform Medicaid reimbursement and improve health outcomes, also addresses the challenge and calls for clear and consistent federal guidance.
view more »Calls for HHS to establish specific criteria for approval, document how programs will address the health of low-income populations, and ensure federal funding is not duplicated.
view more »Association Urges CMS to Ensure Medicaid Payment Sustainability
April 28, 2015 ||In an April 28 letter, the association urged CMS to adopt a holistic view of how payment mechanisms impact essential hospitals, including sustainable base payment rates, Medicaid waivers to address uncompensated care, and DSRIP waivers.
view more »MACPAC Report to Congress Examines CHIP, Premium Assistance Waivers
March 17, 2015 ||Report includes potential impact if CHIP was to expire, Section 1115 waivers used to expand Medicaid coverage, and other aspects of Medicaid payment policy.
view more »The Complex Situation Surrounding Patients’ Immigration Status
Nov. 12, 2014 ||Essential hospitals face barriers in providing care to immigrant populations. They must find unique ways to address the complexity surrounding immigration status for their patients.
view more »Medicaid Incentive Programs: Hospital Perspectives from Three States
Sept. 18, 2014 ||The third in a series of waiver-related briefs, this research brief summarizes perspectives from hospital leaders in Massachusetts, California, and Texas.
view more »Budget Neutrality Concerns for Arkansas Expansion Waiver
Sept. 9, 2014 ||GAO found that HHS did not ensure budget neutrality when approving Arkansas' Medicaid expansion waiver. Issues include lack of data to corroborate state assumptions and state flexibility to expand spending limits.
view more »Using case studies and related research, America's Essential Hospitals describes how waiver-based incentive programs support essential hospitals' delivery system reform.
view more »Association Releases Medicaid Incentive Program Brief
June 24, 2014 ||America’s Essential Hospitals released a policy brief that discusses approaches to extending the reach of health care transformation through Medicaid waiver incentive programs.
view more »CMS Issues Guidance on Provider-Related Donations under Medicaid
May 13, 2014 ||CMS will not approve SPAs that include non-bona fide donations as a portion, or all, of the non-federal share of Medicaid payments. Payment methodologies contingent upon the receipt of a non-bona fide donation would also be grounds for disapproval of an SPA.
view more »Waivers Catalyze Integration and Clinical Improvement
April 14, 2014 ||Learn how delivery system transformation initiatives helped BMC improve quality
view more »Medicaid Payments to Incentivize Delivery System Reform
Feb. 6, 2014 ||An overview of existing delivery system reform incentive pools and similar models
view more »DSRIP Waiver Implementation: One Hospital’s Experience
Feb. 4, 2014 ||Learn about Santa Clara Valley Medical Center's experience with the DSRIP
view more »Medicaid Section 1115 Demonstrations Rules and Comments
Nov. 25, 2013 ||Section 1115 projects give states additional authority to design, improve Medicaid and CHIP programs
view more »Key Features of State 1115 Demonstration Projects
May 4, 2005 ||