Using Section 1115 Waiver Authority to Implement Beneficiary Contribution Programs in Medicaid

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April 2019

A number of states have requested Section 1115 waiver authority to implement policy changes for low-income adults not eligible for Medicaid on the basis of disability that mirror commercial benefit and enrollment design. These include beneficiary contribution requirements such as premiums, which are typically linked to health savings-like accounts or incentives to complete certain healthy behavior activities. The Centers for Medicare & Medicaid Services have granted waivers to ten states—Arizona, Arkansas, Indiana, Iowa, Kentucky, Michigan, Maine, Montana, New Mexico, and Wisconsin—to adopt such programs.

This brief provides an overview of each state’s beneficiary contribution policies and goals. For states with well-established programs, it discusses the activities and challenges associated with implementation as well as available results.

Publication Type: Issue Briefs

Tags: cost sharing, Medicaid expansion, new adult group, premiums, Section 1115 research and demonstration project waivers