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1115 Waiver Research and Demonstration Projects

PURPOSE: Section 1115 of the Social Security Act provides the Secretary of Health and Human Services with broad authority to authorize experimental, pilot, or demonstration project(s) which, in the judgement of the Secretary,(are) likely to assist in promoting the objectives of (the Medicaid statute).

More information is available regarding these waivers here on CMS's website. Learn about the Steps in the 1115 process, get a List of Comprehensive Health Care Reform Demonstrations (PDF 169KB), or look at a Map of Comprehensive State Health Reform Demonstrations. You can also access more information about Medicaid Managed Care.

FEATURES

1. GENERAL FEATURES: flexibility under section 1115 is sufficiently broad to allow States to test substantially new ideas of policy merit. States commit to a policy experiment that will be evaluated. Section 1115 should demonstrate something that has not been demonstrated on a widespread bases, the specific research / demonstration finding will be drawn from the projects results.

2. ELIGIBILITY/ADDITIONAL SERVICES: the authority provides flexibility, under the Secretary's discretion, for the provision of services which are not otherwise matchable, allows for the expansion of eligibility for those who would otherwise not be eligible for the Medicaid program.

3. EVALUATION/REPORTING REQUIREMENTS: CMS maintains the responsibility to evaluate the project. This includes: state specific and cross-state analyses of impact on utilization, insurance coverage, public and private expenditures, quality, access, and satisfaction.

4. TIME: States can discuss potential demonstration project concepts with CMS early in the process. Projects are generally approved to operate for a five year period.

5. HEALTH CARE REFORM DEMONSTRATIONS: State can expand managed care to include HMOs, partially capitated systems, primary care case managers, or other variations. Oftentimes savings are acheived from managed care arrangements and used to finance coverage to individuals previously ineligible for Medicaid.

6. FINANCIAL: the demonstration must be budget neutral over the life of the project (generally 5 years), and is subject to OMB, CMS, and Departmental approval. The demonstrations cannot be expected to cost the Federal government more than it would cost without the waiver.

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Last Modified on Thursday, September 16, 2004