Section 1115 Waivers

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. 

Waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS) and often vary from one administration to another. In 2018, CMS invited states to submit Section 1115 waiver proposals to condition Medicaid on meeting a work requirement and subsequently has approved the first waivers of that type in the history of the Medicaid program. Federal courts have struck down work requirements in states that with approved waivers in suits brought by advocates, but have not ruled that work requirements can never be approved under Section 1115. In early 2020, the Trump Administration unveiled a proposal to allow states to turn parts of their Medicaid programs into a block grant, under which states would get a fixed payment each year in exchange for gaining unprecedented flexibility in running the Medicaid program. Governor Stitt has expressed strong support for using this new waiver authority as a mechanism to expand Medicaid.

Oklahoma’s SoonerCare Choice and Insure Oklahoma programs operates under an 1115 demonstration waiver that was first granted in the 1990s and has been amended and renewed several times. As of January 2020, Oklahoma has a pending 1115 waiver application to impose a work reporting requirement on Medicaid members.