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, Pennsylvania, Michigan, and New Hampshire—have used Section 1115 research and demonstration waivers to extend coverage to this new adult group. Pennsylvania’s waiver is no longer operational as the state transitioned to a traditional Medicaid expansion effective September 1, 2015. An additional state, Kentucky, received federal approval to implement an expansion waiver in January 2018.
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. Arkansas, Indiana, and Iowa fact sheets have been updated to reflect extensions of certain provisions approved in late 2016, as well as CMS’s approval of Iowa’s request to waive retroactive coverage and Indiana’s request to change its premium structure in late 2017.
Publication Type: Issue Briefs