1115 Waiver
Section 1115 of the Social Security Act gives states the flexibility to design and improve their programs, and to demonstrate and evaluate state-specific policy approaches to better serve Medicaid populations.
When a state submits an 1115 waiver proposal, the Centers for Medicare and Medicaid Services (CMS) reviews the proposal to determine whether its stated objectives are aligned with federal policies and regulations. 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 demonstration. Generally, section 1115 demonstrations are approved for an initial five-year period and can be extended for up to an additional three to five years, depending on the populations served.