Medicaid Waivers - 25 Years of Breaking Down Barriers to Health and Well-being

Aug 31, 2026

Medicaid Waivers explains how Medicaid states use federal waivers to customize eligibility rules, service comparability, and statewideness. It outlines why waivers exist, how they are created through collaboration with CMS, and highlights the public input process that can shape waiver priorities. The webinar reviews major waiver types, including 1915(c), 1915(i), and 1915(k), plus Sections 1115 and 1332, and details how engagement can support expansions or challenge restrictive changes.

LanguageEnglish

CategoryPresentations

FormatPPTX

Pages32

Reading Time11 min

AccessFree to download

Agenda

Recommendations

Introduction

Understanding and Acting on Medicaid Policy

Brief Background on Medicaid

Waiver Summary

Why Do Waivers Exist? How Are They Created?

An Incomplete List of Waivers

1915(c) Home & Community Based Services Waiver

1915(i) Home & Community Based Services

1915(k) Community First Choice Waiver

Section 1115 Medicaid Demonstration Waivers

Section 1332 State Innovation Waivers

Importance of Engagement

Waiver Process

How to Get Involved in Waiver Creation and Approval

Medicaid Waiver Timeline

Who Decides a Waiver is Needed?

Medicaid Waivers 25 Years of Breaking Down Barriers to Health and Well-being October, 2017 Understanding and Acting on Medicaid Policy 25 Years of Breaking Down Barriers to Health and Well-being Agenda Recommendations 25 Years of Breaking Down Barriers to Health and Well-being Introduction Introduction Q/A Waiver Summary Waiver Process Medicaid Waiver Summary 25 Years of Breaking Down Barriers to Health and Well-being Familiarize Yourself with State Medicaid Waivers 25 Years of Breaking Down Barriers to Health and Well-being Importance of Understanding the Waiver Process A state’s decision to write a waiver can be based on budget needs, federal priorities, or advocacy at the local, state or federal level. Advocates have often played a critical role in shaping priorities: Money Follows the Person Community First Choice Option Under the current administration, waiver priorities could shift towards programs that place added restrictions on Medicaid Work-requirements Premium/Cost sharing (see HIP 2.0) Once you understand the public input process, you can effectively push for or against changes in your state’s Medicaid system. Introduction Waiver Process Q/A Waiver Summary 25 Years of Breaking Down Barriers to Health and Well-being Brief Background on Medicaid Created in 1965 Administered at state level but guided by state and federal regulation. Funded through a combination of state and federal dollars (FMAP or ‘federal match’). Largest U.S. health care plan for low income individuals, including people with disabilities and children Introduction Waiver Process Q/A Waiver Summary 25 Years of Breaking Down Barriers to Health and Well-being Why Do Waivers Exist? How Are They Created? Waivers exist as a way for states to customize their Medicaid program. They are called ‘waivers’ because, when approved, they have the power to waive federal requirements around things like: eligibility, comparability of services; and statewidedness. States can apply for waivers that tackle one issue (e.g., home and community based services) or a broad goal (e.g., shifting from fee-for-service to Medicaid managed care). While states can begin the process of writing a waiver, they must work with Centers for Medicare and Medicaid Services (CMS) before it is approved. Introduction Waiver Process Q/A Waiver Summary 25 Years of Breaking Down Barriers to Health and Well-being An Incomplete List of Waivers Introduction Waiver Process Q/A Waiver Summary Section 1115 Section 1332 Section 1915(c) Section 1915(i) Section 1915(k) Home and Community-Based Services Community First Choice Waiver Medicaid Demonstration Waivers State Innovation Waivers 25 Years of Breaking Down Barriers to Health and Well-being 1915(c) Home & Community Based Services Waiver Introduction Waiver Process Q/A Waiver Summary Allows states to provide services to those who qualify for institutional levels of care Targets home and community-based services to specific populations based on age or diagnosis 25 Years of Breaking Down Barriers to Health and Well-being 1915(i) Home & Community Based Services Introduction Waiver Process Q/A Waiver Summary Created through the Affordable Care Act (ACA) Allows states to offer Home and Community Based Services as a part of the Medicaid state plan instead of through a waiver. Saves money in the long run Services cannot be limited by number of participants Expanded coverable services to include: any of the HCBS permitted under section 1915(c) HCBS waivers, certain services for individuals with mental health and substance use disorders; and, other services requested by a state and approved by the Secretary of Health and Human Services. 25 Years of Breaking Down Barriers to Health and Well-being 1915(k) Community First Choice Waiver Introduction Waiver Process Q/A Waiver Summary 6% increase in matching federal dollars (FMAP) for HCBS provided under State Plan No time limit or expiration date Statewide eligibility Applied in 5 states Oregon example: Coverage f

FAQs

Why do Medicaid waivers exist and what requirements can they waive?

Waivers let states customize their Medicaid program. When approved, they can waive federal requirements related to eligibility, comparability of services, and statewideness.

What is the role of CMS in the waiver creation process?

States can begin drafting waivers, but approval requires working with the Centers for Medicare and Medicaid Services (CMS) before the waiver can be finalized.

How do different waiver types (1915(c), 1915(i), 1915(k), 1115, and 1332) differ in purpose?

1915(c) targets home and community-based services for specific populations needing institutional-level care, while 1915(i) offers HCBS through the state plan under ACA. 1915(k) increases FMAP for HCBS with statewide eligibility and no expiration, whereas 1115 supports broader Medicaid policy changes and 1332 enables state experimentation with coverage models for fixed renewal periods.

Aug 31, 2026

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