Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State – KFF

 

Report on Section 1115 Medicaid Waivers and Their Role in Advancing Sustainable Development Goals

Introduction: A Framework for Health Innovation and Sustainable Development

Section 1115 Medicaid demonstration waivers represent a critical policy instrument for United States authorities to advance public health objectives. These waivers grant states the flexibility to pilot innovative approaches within their Medicaid programs, deviating from federal statutes when such initiatives are projected to promote the program’s core objectives. This mechanism is instrumental in pursuing several United Nations Sustainable Development Goals (SDGs), primarily by fostering innovation in healthcare delivery and coverage for vulnerable populations.

The implementation of these waivers reflects a dynamic partnership between state and federal governments, aligning with shifting health priorities and contributing directly to a more sustainable and equitable future. Nearly every state utilizes at least one Section 1115 waiver, demonstrating their widespread importance as a tool for progress.

Direct Contribution to SDG 3: Good Health and Well-being

The primary function of Section 1115 waivers is to enhance the Medicaid program, which directly aligns with SDG 3: Ensure healthy lives and promote well-being for all at all ages. By testing new models of healthcare, states can improve health outcomes and increase access to quality essential health-care services.

• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. Waivers that expand eligibility or streamline enrollment processes are direct efforts toward this target.

Broader Impact on Interconnected SDGs

The flexibility afforded by Section 1115 waivers allows states to address the complex, interconnected nature of sustainable development. The impact of these health initiatives extends beyond SDG 3, contributing to a range of global goals:

1. SDG 1 (No Poverty): By providing a health safety net, Medicaid prevents medical costs from driving individuals and families into poverty.
2. SDG 10 (Reduced Inequalities): Waivers can be specifically designed to target health disparities among different population groups, ensuring more equitable access to care and better outcomes for marginalized communities.
3. SDG 17 (Partnerships for the Goals): The waiver process is an embodiment of public-public partnership, requiring collaboration between state and federal entities to achieve shared health and development objectives.

Key Areas of Waiver Innovation for SDG Advancement

The tracking of approved and pending Section 1115 waivers reveals several key themes where states are focusing their efforts. These areas are pivotal for making substantive progress on the SDGs.

Strategic Focus Areas

• Eligibility and Enrollment: Waivers modifying eligibility criteria are fundamental to expanding health coverage, directly supporting SDG 3 and SDG 10 by bringing more low-income individuals into the healthcare system.
• Benefits and Services: Innovations in covered benefits, such as adding services for mental health or substance use disorders, enhance the quality and comprehensiveness of care, contributing to overall well-being (SDG 3).
• Social Determinants of Health (SDOH): A growing number of waivers seek to address non-medical factors that influence health outcomes, such as housing instability and food insecurity. This holistic approach is crucial for achieving SDG 1, SDG 3, and SDG 10 by tackling the root causes of poor health and inequality.
• Delivery System Reforms: States use waivers to test new payment and delivery models aimed at improving efficiency and quality of care. These reforms are a form of institutional innovation that supports the robust health systems needed for SDG 3.

Monitoring and Governance for Sustainable Outcomes

A Collaborative Approach to Health System Strengthening

The governance of Section 1115 waivers, involving state proposals and federal approval, reflects a multi-level partnership consistent with SDG 17. While priorities may evolve with different presidential administrations, the continuous process of waiver application and review ensures that state Medicaid programs can adapt to meet emerging health challenges.

Tracking Progress Towards Health Equity

Systematic tracking of waiver provisions is essential for accountability and for understanding national trends in healthcare innovation. Monitoring waiver activity related to eligibility, benefits, and SDOH provides critical data on how policy is being leveraged to reduce health disparities (SDG 10) and move closer to the goal of universal health coverage (SDG 3).

SDGs Addressed in the Article

SDG 3: Good Health and Well-being

• The article focuses on Section 1115 Medicaid demonstration waivers, which are directly related to providing health services. Medicaid is a public health program, and the waivers allow states to “test new approaches in Medicaid” to deliver healthcare. This directly connects to the goal of ensuring healthy lives and promoting well-being.

SDG 1: No Poverty

• Medicaid is a social protection program for low-income individuals and families. The article mentions that waivers can alter “eligibility” for the program. By providing access to healthcare, Medicaid helps protect vulnerable populations from high medical costs, which is a key factor in preventing and alleviating poverty.

SDG 10: Reduced Inequalities

• The article discusses how waivers can lead to “expansions and restrictions” in eligibility and benefits for Medicaid, a program designed for a specific economic group. These policy changes directly impact equality of access to healthcare. The mention of addressing “social determinants of health” also points to efforts to reduce health inequalities that arise from social and economic factors.

Specific SDG Targets Identified

Target 3.8: Achieve universal health coverage

• The entire article is about Medicaid, a key component of the U.S. health coverage system. The waivers are described as an “avenue to test new approaches in Medicaid” and can affect “eligibility, benefits, and social determinants of health.” This directly relates to the effort to achieve universal health coverage by experimenting with and potentially expanding access to essential health services for low-income populations.

Target 1.3: Implement nationally appropriate social protection systems

• Medicaid is a fundamental social protection system in the United States. The article explains that Section 1115 waivers allow states “additional flexibility in how they operate their programs,” which directly impacts the implementation and coverage of this social protection system for the poor and vulnerable.

Target 10.2: Empower and promote the social, economic, and political inclusion of all

• The waivers can either expand or restrict access to Medicaid, thereby affecting the inclusion of low-income individuals in essential health services. Policies that change “eligibility” criteria are central to determining who is included or excluded from this vital social safety net.

Indicators Mentioned or Implied

Indicator for Target 3.8 (Implied)

• The article states that it “tracks approved and pending Section 1115 waiver provisions (including expansions and restrictions) related to eligibility, benefits, and social determinants of health.” This implies the use of indicators to measure progress, such as:
  • The number of states with approved waivers expanding health benefits.
  • The proportion of the low-income population covered by Medicaid waivers.
  • Changes in the scope of services covered under Medicaid (e.g., inclusion of services addressing social determinants of health).

Indicator for Target 1.3 (Implied)

• The tracking of “expansions and restrictions” related to “eligibility” directly implies an indicator for social protection coverage. A measurable indicator would be:
  • The number of people gaining or losing eligibility for Medicaid as a result of waiver provisions.

Indicator for Target 10.2 (Implied)

• The article’s focus on tracking waiver provisions that affect eligibility and benefits for a specific economic group implies an indicator for inclusion. An implied indicator is:
  • The number of states implementing waivers that expand versus those that restrict access to healthcare for low-income populations, thereby measuring policy trends toward or away from greater equality.

Summary Table of SDGs, Targets, and Indicators

SDGs	Targets	Indicators (Implied from the article)
SDG 3: Good Health and Well-being	Target 3.8: Achieve universal health coverage, including financial risk protection and access to quality essential health-care services.	Number of states with approved waivers related to “eligibility, benefits, and social determinants of health.” Scope of health benefits covered under new waiver provisions.
SDG 1: No Poverty	Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and achieve substantial coverage of the poor and the vulnerable.	Number of states with approved “expansions and restrictions” to Medicaid eligibility, affecting coverage of the poor.
SDG 10: Reduced Inequalities	Target 10.2: Empower and promote the social, economic, and political inclusion of all, irrespective of economic or other status.	Number of states implementing policies that expand or restrict access to healthcare for low-income populations.

Source: kff.org