Understanding State 1115 Waivers Designed to Reduce Medicaid Eligibility
<p>To shrink Medicaid eligibility and enrollment, the Trump administration is encouraging states to use Section 1115 demonstration waivers, which allow the U.S. Department of Health and Human Services and the states to test innovations in Medicaid and other public welfare programs without formal legislative action. Guidance released today by the Centers for Medicare and Medicaid Services could speed up the approval of such demonstrations.</p><p>As George Washington University’s Sara Rosenbaum and colleagues explain on <em>To the Point,</em> these demonstrations could add conditions for Medicaid coverage, such as work requirements, monthly premium obligations, and limits on how long beneficiaries can be enrolled. The administration also could allow states to replace Medicaid’s core safety-net feature — enrollment when health care is needed — with a single annual sign-up period.</p>
<p>The researchers examine waiver proposals submitted by 10 states — Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah, and Wisconsin — for insight into this new generation of Medicaid demonstrations. A key question, they say, is whether imposing criteria that result in the loss of health coverage, or the future denial of benefits, falls within the scope of 1115 waivers.</p>