Medicaid Waivers

Advocates and Healthcare Providers File Brief in Case Challenging the Kentucky Medicaid Waiver
As reported in previous Updates, the administration has been supportive of waivers to establish “community-engagement” (work, education) requirements on Medicaid beneficiaries. See 1115 Community Engagement Initiative on the Centers for Medicare and Medicaid Services (CMS) website CMS has approved several such waivers in various forms, some of which have been challenged in court. A federal district court invalidated the Kentucky waiver, remanding it to the Department of Health and Human Services (HHS) for reconsideration. After the administration reapproved the waiver in November 2018, the approval was challenged again in court. In January, an amicus (friend-of-the-court) brief was submitted by the American Academy of Pediatrics, American College of Physicians, the American Medical Association, American Psychiatric Association, Catholic Health Association of the United States, March of Dimes, and National Alliance on Mental Illness. As explained in Health Care Providers, Advocates Explain Harm of Medicaid Work Requirements (blog post from the Center on Budget and Policy Priorities, 2/21/19), the amicus brief argues that work requirements can harm Medicaid beneficiaries in several ways.

WORTH REPEATING: Updated 1915(c) Waiver Application
On January 28, 2019, CMS released a revised application and technical guide for Medicaid 1915(c) waivers, used to provide home-and community based services. According to this information provided by the National Association of States United on Aging and Disabilities, the application includes some notable additions and modifications including:

  • A request for information about whether the state administers any quality of life/quality of care surveys of waiver participants, such as the NCI or NCI-AD surveys; and
  • Updates to several sections to reflect recent guidance and policy developments, including the sections on public input and self-direction.

View the updated waiver instructions.
View the updated waiver application form.

Medicaid Resources

WORTH REPEATING: The Kaiser Family Foundation has released a new brief, Section 1115 Medicaid Demonstration Waivers: The Current Landscape of Approved and Pending Waivers. The brief discusses some of the newer elements of Medicaid waivers, including “community-engagement” (work, etc.) requirements, substance-abuse initiatives, and the use of Medicaid to pay for services to address the social determinants of health (a North Carolina pilot program to address housing instability, transportation, food insecurity, and interpersonal violence and toxic stress).


  • Approved and pending Medicaid waiver applications can be found on gov.
  • The Kaiser Family Foundation regularly updates its state-by-state §1115 Medicaid Waiver Tracker, and also provides related waiver resources and definitions.

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