Medicaid Reform, Innovations and Waivers

Medicaid Reform, Innovations and Waivers



Funding ongoing Medicaid programs is one of the greatest challenges for states. The state’s share of the joint state-federal program accounts for an average of 15 percent of state general funds and about 21 percent of total state spending when federal funds are added to the mix. Many policymakers think short-term fixes to Medicaid, including cuts in services, won’t do the trick. Lawmakers are focusing on how to bring down the costs of Medicaid for the long term.





Medicaid—a federal/state partnership with shared authority and financing—is currently a public health coverage program for low-income children, their parents, the elderly and people with disabilities. Medicaid pays for health and long-term care services for more than 55 million people.  Although participation is optional, all 50 states participate. Section 1115 of the Social Security Act gives the secretary of Health and Human Services authority to waive provisions of the law to encourage state innovation and experimental demonstrations in Medicaid.  States have tested a wide range of policy approaches under 1115 waivers, including  offering coverage to otherwise ineligible populations, providing services not typically covered by Medicaid, experimenting with cost sharing and other payment reforms, and implementing changes to the delivery system.  In 2012, 30 states and the District of Columbia are operating at least one 1115 waiver.

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  • Medicaid Workforce

    The video on this page looks at the challenges of ensuring there is an adequate supply of health care providers for the additional patients entering the Medicaid system.

  • Medicaid

    This page contains information about the Medicaid program and offers links to other NCSL resources about Medicaid.

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