Section 1115 Demonstrations
About Section 1115 Demonstrations
Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs. The purpose of these demonstrations, which give States additional flexibility to design and improve their programs, is to demonstrate and evaluate policy approaches such as:
- Expanding eligibility to individuals who are not otherwise Medicaid or CHIP eligible
- Providing services not typically covered by Medicaid
- Using innovative service delivery systems that improve care, increase efficiency, and reduce costs.
In general, section 1115 demonstrations are approved for a five-year period and can be renewed, typically for an additional three years. Demonstrations must be “budget neutral” to the Federal government, which means that during the course of the project Federal Medicaid expenditures will not be more than Federal spending without the waiver.
View Section 1115 Demonstration List
Note: This website provides policy information and data on demonstration projects in participating States.
If you are looking for health coverage in your State or to learn more about applying for Medicaid, please go to www.healthcare.gov.
Public Comments
The Affordable Care Act requires opportunity for public comment and greater transparency of the section 1115 demonstration projects. A final rule, effective on April 27, 2012, establishes a process for ensuring public input into the development and approval of new section 1115 demonstrations as well as extensions of existing demonstrations. This final rule sets standards for making information about Medicaid and CHIP demonstration applications and approved demonstration projects publicly available at the State and Federal levels. The rule ensures that the public will have an opportunity to provide comments on a demonstration while it is under review at CMS. At the same time, the final rule ensures that the development and review of demonstration applications will proceed in a timely and responsive manner.
Final Rule-Review and Approval Process for Medicaid and CHIP Section 1115 Demonstrations
Section 1115 Demonstration Transparency State Health Official Letter
View and comment on pending section 1115 demonstrations
How States Apply
CMS will soon make available on this website an interim section 1115 demonstration application template. The template will include the components of a complete application and it will be available for use by States at their option. States may submit completed applications to 1115demorequests@cms.hhs.gov. In early 2013, CMS will make available a web-based system that States can use to submit section 1115 demonstration applications electronically. This system will streamline the State application process and CMS review of pending actions.