Module 4
Section 1115 Waivers
The widest door in Medicaid law. How states test delivery reform, coverage, and social-needs benefits, and why the landscape shifts with each administration.
By the end of this module, you will be able to:
- Explain what Section 1115 authority allows and what budget neutrality requires
- Describe the range of reforms states have tested through demonstration waivers
- Judge the stability of a social-needs benefit from the authority behind it
- What a Section 1115 Waiver Is Section 1115 lets states test ideas that ordinary Medicaid rules would not allow. This lesson explains the authority and its one big constraint. About 5 min
- What States Test With 1115s Delivery-system reform, coverage, addiction treatment, and contested eligibility conditions have all run through 1115 waivers. This lesson surveys the range. About 5 min
- 1115s and Social Needs For a few years, 1115 waivers became the main way states covered housing and food. Then the federal framework was rescinded. This lesson tells that story accurately. About 5 min
Module quiz
Answer all questions to see your score.
1. What makes Section 1115 authority unusually powerful?
Section 1115 combines broad waiver authority with expenditure authority to match otherwise-unallowed spending, which is why so much Medicaid innovation runs through it.
2. DSRIP programs, funded through 1115 waivers, paid providers for what?
Delivery System Reform Incentive Payment programs tied large federal pools to reform milestones rather than volume; most have since wound down.
3. What is the current federal status of the 2023 framework for covering social needs through 1115s?
The November 2023 framework was rescinded on March 4, 2025. New requests get case-by-case review, while the roughly 18 existing approvals were not canceled.