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.
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.
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.
How States Apply
For new section 1115 demonstrations, states now have the option of using an interim template to develop their applications. States may either download and complete the template, or simply use it as a guide as they develop the application. States may submit completed applications to firstname.lastname@example.org. In 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.
Section 1937 of the Social Security Act as in effect in 2009 – This document provides the statutory language in effect as of December 1, 2009 and may be helpful to section 1115 demonstration states analyzing benefits provided to certain demonstration eligible as of that date.”