OKPOLICY.ORG
Section 1115 Medicaid waivers, or 1115 waivers, are waivers from federal Medicaid law intended to give states an avenue to test new approaches in Medicaid that differ from what is required by federal statute.
Section 1115 of the Social Security Act gives the Secretary of the Department of Health and Human Services authority to approve experimental, pilot, or demonstration projects that test and evaluate state-specific policy changes in Medicaid and CHIP programs to improve care, increase efficiency, and reduce costs without increasing federal Medicaid expenditures.
Oklahoma’s SoonerCare program operates under an 1115 demonstration waiver that was first granted in the 1990s and has been amended and renewed several times. In December 2025, the federal Centers for Medicare and Medicaid Services (CMS) granted Oklahoma a temporary extension of the 1115 SoonerCare waiver through the end of December 2026. In 2022, CMS approved an additional 1115 waiver for Institutions for Mental Disease Waiver for Serious Mental Illness/Substance Use Disorder. That waiver was scheduled to expire December 31, 2025.
Waivers generally reflect priorities identified by states and CMS and often vary from one state and federal administration to another. Under the first Trump Administration, Oklahoma submitted waiver applications to impose a work reporting requirement on Medicaid members and to partially turn Medicaid into a block grant program (SoonerCare 2.0); both applications were eventually withdrawn.
