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 2022, CMS approved an additional 1115 waiver for Institutions for Mental Disease Waiver for Serious Mental Illness/Substance Use Disorder.
Waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS) and often vary from one state and federal administration to another. Under the 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members and to partially turn Medicaid into a block grant program (SoonerCare 2.0); both applications were eventually withdrawn.