Health Affairs January 26, 2023
States seeking to innovate in Medicaid may need programmatic flexibility and federal funding that goes beyond what would ordinarily be permitted. Section 1115 of the Social Security Act enables the secretary of the Department of Health and Human services to provide that flexibility and funding to test innovations in the Medicaid program, so long as those innovations meet 1115 criteria, most notably that they further the objectives of the Medicaid program. Demonstrations authorized under section 1115 are a major source of innovation in the Medicaid program for many states and are frequently used to expand eligibility, cover new benefits, or reform health care delivery systems.
The Centers for Medicare and Medicaid Services (CMS) have long required that section 1115 demonstrations...