As of December 2024, several significant developments have occurred concerning Medicaid’s Section 1115 waivers in the United States, including notable initiatives in Pennsylvania:
- Pennsylvania’s “Keystones of Health” Demonstration Approval: On December 26, 2024, the Centers for Medicare & Medicaid Services (CMS) approved Pennsylvania’s Section 1115 demonstration waiver, titled “Bridges to Success: Keystones of Health for Pennsylvania.” This initiative aims to address health-related social needs (HRSNs) by providing services in four key areas: reentry support for incarcerated individuals, housing assistance, food and nutrition services, and continuous Medicaid coverage for children under six years old. The demonstration is set to be effective from December 26, 2024, through December 31, 2029.
- Virginia’s Waiver Amendment for Serious Mental Illness (SMI): The Virginia Department of Medical Assistance Services (DMAS) announced plans to submit an amendment to its “Building and Transforming Coverage, Services, and Supports for a Healthier Virginia” Section 1115 Demonstration waiver. This amendment seeks authority to cover services for individuals with serious mental illness (SMI) in institutions for mental diseases (IMDs), expanding the state’s capacity to address mental health needs.
- New York’s Social Care Networks (SCNs) Initiative: New York State advanced its Medicaid Redesign efforts by developing Social Care Networks (SCNs) under its Section 1115 waiver. These networks aim to integrate physical, behavioral, and social care services through shared data and technology, addressing health-related social needs (HRSNs) to improve health equity and outcomes.
- Wisconsin’s BadgerCare Reform Demonstration Project Amendment: Wisconsin submitted an amendment to its BadgerCare Reform Demonstration Project, seeking to implement changes under its Section 1115 waiver. While specific details of the amendment were not disclosed, such submissions typically aim to modify eligibility, benefits, or delivery systems within the state’s Medicaid program.
- Ongoing Discussions on Medicaid Work Requirements: The debate over Medicaid work requirements continued, with some states expressing interest in implementing such provisions through Section 1115 waivers. The previous Trump administration had approved waivers conditioning Medicaid coverage on meeting work and reporting requirements, a policy that faced legal challenges and was subsequently rolled back by the Biden administration. The current administration’s stance on this issue remains a topic of interest.
Analysis of Section 1115 Waivers Under the Trump Administration:
During the Trump administration, there was a notable shift in the focus of Section 1115 waivers. The administration emphasized work requirements and other eligibility restrictions, approving waivers that conditioned Medicaid coverage on meeting work and reporting requirements. Thirteen states received such approvals, marking a significant change in Medicaid policy.
Additionally, the Trump administration approved waivers that included capped financing and payment for institutional behavioral health services. These policies aimed to reshape Medicaid by introducing elements that were unprecedented in the program’s history.
However, many of these initiatives faced legal challenges and were met with resistance from various stakeholders. The subsequent administration took steps to withdraw or phase out several of these waiver provisions, particularly those related to work requirements, concluding that they did not promote the objectives of the Medicaid program.
In summary, while the Trump administration actively utilized Section 1115 waivers to implement significant changes in Medicaid policy, many of these changes were contested and have since been reversed or are under reconsideration. The future trajectory of Section 1115 waivers will depend on ongoing policy discussions and administrative priorities.
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