Skip to Main Content

Restrictive Medicaid 1115 Waivers: Status in the States


Update 2/5/2019:
 On January 18, 2019, CMS approved an amendment to Arizona’s 1115 waiver that added a work requirement, premiums, and waived retroactive eligibility. CMS denied Arizona’s request to add time limits on Medicaid eligibility.

An increasing number of states are making harmful changes to their Medicaid programs using “Section 1115 waivers.” Families USA is tracking state Medicaid waivers that restrict access to quality, affordable health care for low-income families and adults. This new grid offers an overview of the status of each state’s waiver proposal, the restrictive elements of the waiver proposal, and CMS’s decision on each element. Families USA will be updating the grid regularly to reflect new waiver proposals and CMS decisions on each element of the proposal. View our interactive map for more details on each state.

The Trump administration gave states green light to impose barriers to Medicaid coverage

The Centers for Medicare and Medicaid Services (CMS) released a State Medicaid Director Letter in January, providing new guidance for Section 1115 waiver proposals. The new guidance allows states to impose work requirements as a condition of Medicaid eligibility, reversing long-standing CMS policy that work requirements did not promote the objectives of the Medicaid program and were therefore unlawful.

Under CMS’s new guidance, many states have now submitted, or are in the process of submitting, 1115 Medicaid waiver proposals to CMS that include a work requirement provision.

In addition to work requirements, states are also including a number of provisions in their proposals to CMS that aim to restrict access to or limit the scope of benefits in the Medicaid program. Some of those provisions include: drug testing as a condition of eligibility; being disenrolled and “locked-out” of coverage; omitting required Medicaid benefits such as Non-Emergency Medical Transport or Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for children up to age 21.

Families USA will be updating the grid regularly to reflect new waiver proposals, and CMS decisions on each element of the proposal.