State Medicaid programs must comply with federal requirements, but states seeking additional flexibility can apply for formal waivers of some of these requirements from the Secretary of Health and Human Services (HHS). For example, states can use waivers to offer an alternative benefit plan to a subset of Medicaid beneficiaries, to restrict enrollees to a specific network of providers, or to extend coverage to groups beyond those defined in Medicaid law. The extensive use of waivers (every state now has at least one Medicaid waiver agreement in place) has contributed to wide variations in program design, covered services, and eligible populations among states and even within states.

Learn more

Featured publications

Medicaid Work and Community Engagement Requirements

April 2019 |

A number of states have requested Section 1115 waiver authority to impose work and community engagement requirements as a condition of Medicaid eligibility.  The Centers for Medicare & Medicaid Services (CMS) has granted waivers to ten states—Arizona, Arkansas, Indiana, Kentucky, Maine, Michigan, New Hampshire, and Ohio, Utah, and Wisconsin—to adopt work and community engagement requirements […]

Streamlining Medicaid Managed Care Authority

March 2018 | ,

Managed care is now the dominant delivery system in Medicaid, with the share of beneficiaries enrolled in any form of managed care growing from 58 percent in 2002 to 80 percent in 2015. States can use three separate legal authorities to implement a Medicaid managed care program: Section 1115 waiver authority, Section 1915 waiver authority, […]