Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. SDOH include but are not limited to housing, food, education, employment, healthy behaviors, transportation, and personal safety. As outlined in CMS’s 2021 guidance, states can request federal matching funds through Section 1115 to test the effectiveness of providing SDOH-related services and supports or test alternative payment methodologies designed to address SDOH.
In December 2022, CMS announced a Section 1115 demonstration waiver opportunity to expand the tools available to states to address enrollee “health-related social needs” (or “HRSN”). In November 2023, CMS issued a detailed Medicaid and CHIP HRSN Framework accompanied by an Informational Bulletin (CIB). The “HRSN Waivers” map below identifies states with approval under the new HRSN framework. The “All SDOH Waivers” map identifies SDOH-related 1115 waivers more broadly, including those that pre-date or were approved outside of the new HRSN framework. For more information, refer to KFF’s Medicaid Waiver Tracker (“SDOH” table) and HRSN waiver watch (March 2024).
In April 2023, CMS released guidance encouraging states to apply for a new Section 1115 demonstration opportunity to test transition-related strategies to support community reentry for people who are incarcerated. This demonstration allows states a partial waiver of the inmate exclusion policy, which prohibits Medicaid from paying for services provided during incarceration (except for inpatient services). Reentry services aim to improve care transitions and increase continuity of health coverage, reduce disruptions in care, improve health outcomes, and reduce recidivism rates. The map below identifies states with approved and pending waivers to provide pre-release services to Medicaid-eligible individuals who are incarcerated. For more information, refer to KFF’s Medicaid Waiver Tracker (“Eligibility Changes” table) and related pre-release waiver watch (August 2024).
The Consolidated Appropriations Act, 2023 required all states to implement 12-month continuous eligibility for children beginning on January 1, 2024. States may request Section 1115 waiver authority to provide continuous eligibility for children for longer than 12 months (e.g., from birth to age 6). The map below displays states with approved and pending waivers to extend multi-year continuous eligibility for children. For more information, refer to KFF’s Medicaid Waiver Tracker (“Eligibility Changes” table) and related continuous eligibility waiver watch (February 2024).