Learn more about proposed Medicaid 1115 Waiver amendments for Kentucky, South Carolina, Maine, and Illinois. For more information, reach out to Wesley at publicpolicy@familyvoices.org.
Kentucky – Kentucky’s 1115 proposal would refer Medicaid expansion adults, aged 19-60, who have been on Medicaid for over one year to workforce development resources. The state would provide information about job placement assistance and connect willing participants to services – apprenticeships, career development, education, employment training, and skill-building resources. Participation would not impact benefits or eligibility. The state estimates about 60,000 individuals would be subject to the requirement.
Exempt groups include:
- individuals with verified earned income,
- caregivers of children under 18 years old,
- individuals with diagnosed substance use disorders, serious mental illness,
- individuals with chronic diseases and disabilities,
- pregnant women,
- former foster youth up to age 26, and
- anyone already in a workforce program.
Comments can be submitted via the Medicaid comment portal for Kentucky’s demonstration project. The federal comment period is open from July 10 to August 10, 2025.
South Carolina – South Carolina’s 1115 proposal, Palmetto Pathways to Independence would offer a very limited Medicaid expansion. The expansion would cover parents or caretaker relatives from 67% to 100% of the federal poverty level (FPL) who meet a work reporting requirement. The work requirement would apply to individuals aged 19-64. Those subject to the work requirement must prove the following or be ineligible and/or terminated from coverage:
- 80 hours of work per month,
- Enrollment in education or in the work search process,
- Compliance with SNAP work requirements,
- Compliance with substance use disorder (SUD) treatment, and/or
- Member of the Catawba Nation
The state estimates up to 17,700 people are potentially eligible for coverage, but the state has requested authority to implement an enrollment cap based upon available state funding of up to 11,400 members. The state also includes a waiver request to not provide hospital presumptive eligibility in the demonstration.
Comments can be submitted via the Medicaid comment portal for South Carolina’s Palmetto Pathways to Independence. The federal comment period is open from July 10 to August 9, 2025.
Maine – Maine is seeking a five-year extension for its “Maine Substance Use Disorder (SUD) Care Initiative.” The proposal would rename it to “Maine’s Whole Person Care Waiver,” but continue all existing authorities. Additionally, Maine looks to provide pre-release services to justice-involved populations as well as housing and nutrition health-related social needs services and supports.
Comments can be submitted via the Medicaid comment portal for Maine’s SUD Care Initiative. The federal comment period is open from July 10 through August 9, 2025.
Illinois – Illinois is seeking a five-year extension of its “Illinois Continuity of Care and Administrative Simplification” demonstration. The state is seeking to extend its authority to re-enroll Medicaid beneficiaries into their prior managed care organization (MCO) when the beneficiary submits late redetermination paperwork and is reinstated within 90 days of disenrollment. The state also requests to extend its waiver of hospital presumptive eligibility for an additional 18 months. Additionally, the state is seeking new authority to allow the state to treat out-of-state address changes as reliable based on information from the USPS National Change of Address Database and MCOs when they have received information directly from or verified it with the beneficiary.
Comments can be submitted via the Medicaid portal for Illinois’ Continuity of Care and Administrative Simplification Extension Demonstration. The federal comment period is open from July 16 to August 15, 2025.
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