CMS’ New Policy Framework for Section 1115 Medicaid Demonstrations

Prepared for The Commonwealth Fund

States use Section 1115 demonstrations (also known as waivers) to test innovations in their Medicaid programs. The U.S. Department of Health and Human Services (HHS) has discretion to approve these demonstrations, and, as seen from the history of work-requirement waivers, each administration develops its own waiver policies and priorities.

In recent waiver approvals for Arizona, Arkansas, Massachusetts and Oregon, CMS established a new framework outlining how it will exercise discretion in three important areas:

  • Addressing social drivers of health, which CMS refers to as health-related social needs (HRSN)
  • Allowing federal Medicaid matching funds for health-related programs that were formerly exclusively state-funded
  • Achieving budget neutrality

In a blog post for The Commonwealth Fund, Manatt Health describes CMS’ new framework and how CMS might apply this framework to other states seeking similar waiver and funding flexibilities.

To read the full blog post, click here.



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