As federal health reform legislation has stalled, health policy attention turns to the states, which have many tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states.
Overview of Alternative Medicaid Expansion Waivers
Patricia Boozang, Deborah Bachrach, and Mindy Lipson, Manatt Health
Section 1115 waivers allow states to waive certain Medicaid statutory requirements in order to advance state policy priorities and test innovations in their Medicaid programs, provided that they are budget neutral and “further the goals of the Medicaid program.” Since 2014, seven states have used 1115 waivers to implement alternative Medicaid expansions, and these waivers are likely to be leveraged by states in the next four years to advance changes to Medicaid. This issue brief, developed by Manatt Health, provides an overview of the features of these alternative Medicaid expansion waivers. The document describes how approved waivers have approached aspects including premiums, cost-sharing, Health Savings-like Accounts, healthy behavior incentives, and several others, and can provide insight into state policy priorities and suggest areas where states may seek future waivers.