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Program / 1115 waivers
Medicaid Section 1115 Waivers
The Social Security Act authority that lets the HHS Secretary approve state Medicaid demonstrations outside standard federal rules. VerisGov maps the structure and keeps the state-by-state landscape current.
Coverage Healthcare and Medicaid
At a glance
- Program
- Medicaid Section 1115 research and demonstration waivers, the mechanism for state Medicaid demonstrations outside standard federal requirements.
- Administering agency
- U.S. Department of Health and Human Services through CMS; demonstrations are operated by state Medicaid agencies.
- Statutory authority
- Section 1115 of the Social Security Act.
- Funding mechanism
- Federal matched Medicaid spending. The Secretary may permit federal financial participation for expenditures and populations not otherwise allowed, subject to a budget neutrality expectation.
- Money flow
- Federal match flows to the state for expenditures the Secretary deems allowable under the demonstration's terms and conditions, not as a separate grant award.
- Who has a stake
- State Medicaid agencies, the HHS Secretary and CMS, Medicaid managed care plans and providers, beneficiary advocates, and populations covered or affected by the demonstration.
What it is
Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that the Secretary judges likely to promote the objectives of the Medicaid program. Through this authority the Secretary can waive many Medicaid state plan requirements and allow federal financial participation for costs and populations that standard Medicaid rules would not otherwise cover.
An 1115 demonstration is the primary route states use to test approaches that differ from what federal statute would normally require, from coverage and delivery system changes to programs addressing health-related needs. Approvals are discretionary: the Secretary, through CMS, issues terms and conditions that list the specific provisions being waived, the expenditures allowed, and the evaluation and reporting the state must perform.
Demonstrations are governed by a long-standing budget neutrality expectation, meaning federal spending under the waiver is not supposed to exceed what it would have been without it, even though this is operational policy rather than an explicit statutory mandate. Federal transparency rules add public notice and comment steps, and states must contract with independent evaluators and report on agreed metrics.
Key facts
- Program Medicaid Section 1115 research and demonstration waivers, the mechanism for state Medicaid demonstrations outside standard federal requirements.
- Administering agency U.S. Department of Health and Human Services through CMS; demonstrations are operated by state Medicaid agencies.
- Statutory authority Section 1115 of the Social Security Act.
- Funding mechanism Federal matched Medicaid spending. The Secretary may permit federal financial participation for expenditures and populations not otherwise allowed, subject to a budget neutrality expectation.
- Money flow Federal match flows to the state for expenditures the Secretary deems allowable under the demonstration's terms and conditions, not as a separate grant award.
- Who has a stake State Medicaid agencies, the HHS Secretary and CMS, Medicaid managed care plans and providers, beneficiary advocates, and populations covered or affected by the demonstration.
Program types
- Coverage expansions or eligibility approaches outside standard state plan rules
- Delivery system and payment reform demonstrations
- Programs addressing health-related social needs within Medicaid
- Behavioral health, substance use, and institutional-care policy demonstrations
- Benefit design and cost-sharing experiments approved under terms and conditions
Always current
What VerisGov keeps current
The facts above hold for years. These move, and they are where most of the work is. The engine tracks each one against its government source, so what you see is the live state, not a snapshot that quietly went out of date.
- Which states have approved, pending, or expiring 1115 demonstrations and their scope
- Current federal policy on what the Secretary will and will not approve
- Active terms and conditions, evaluation requirements, and renewal timelines
- How budget neutrality is currently calculated and any legislative changes to that standard
- Public notice, comment, and posting requirements in effect
How VerisGov covers it
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Pinned to records published by
- Centers for Medicare and Medicaid Services (CMS)
- U.S. Department of Health and Human Services
Answers
Frequently asked questions
What can a Section 1115 waiver actually waive?
The Secretary can waive many Medicaid state plan requirements to the extent necessary to carry out a demonstration, and can allow federal financial participation for costs and populations not normally covered. Certain requirements are outside this authority. The specific waived provisions are listed in each demonstration's terms and conditions.
What is budget neutrality?
Budget neutrality is the long-standing expectation that federal spending under an 1115 demonstration will not exceed what federal spending would have been without it. It has been operational policy for many years rather than an explicit statutory command, and how it is calculated can shift with federal guidance and legislation.
How long does an 1115 demonstration last?
Initial approvals typically run for a defined multi-year period, with renewals available for additional periods. Negotiating a comprehensive demonstration can take months to years, and each approval comes with terms, conditions, and evaluation obligations.
How does VerisGov help with Section 1115 waivers?
VerisGov maps the durable structure of the 1115 authority, the statute, the Secretary's discretion, and the matched-financing and budget-neutrality framework, and keeps the volatile landscape current: which states have approved or pending demonstrations, what CMS is approving, active terms and conditions, and changes to the budget-neutrality standard. Every fact is pinned to its source.
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