Expanding Medicaid to the New Adult Group through Section 1115 Waivers

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July 2018 | Medicaid and the Affordable Care Act

The Patient Protection and Affordable Care Act expanded Medicaid coverage to non-elderly adults with incomes at or below 138 percent of the federal poverty level who were not previously eligible for the program. After the U.S. Supreme Court ruling in June 2012 effectively made Medicaid expansion optional, a number of states have pursued alternative approaches to extending coverage to these previously ineligible adults. Seven states—Arizona, Arkansas, Iowa, Indiana, Michigan, Montana, and New Hampshire—are currently using Section 1115 research and demonstration waivers to extend coverage to this new adult group.

Two additional states, Kentucky and Pennsylvania, received approval from the Centers for Medicare & Medicaid Services to implement alternative expansions under Section 1115 authority. However, Kentucky’s waiver approval was vacated and remanded to the U.S. Department of Health and Human Services for further review by the U.S. District Court for the District of Columbia; the state is not moving ahead with implementation at this time and will continue to operate a traditional Medicaid expansion. Pennsylvania’s waiver is no longer operational as the state transitioned to a traditional Medicaid expansion effective September 1, 2015.

This issue brief summarizes the main design features of the expansion waivers, including covered benefits, required premiums and cost sharing, whether the waiver uses a premium assistance program, and how services are delivered (i.e. by fee for service or managed care). State-specific waiver information is summarized at the individual links below.

Publication Type: Issue Briefs

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Tags: adults, Affordable Care Act, benefits, childless adults, copayments, cost sharing, eligibility, Medicaid expansion, new adult group, premium assistance, premiums, waivers