1115 Waiver Amendments At-A-Glance

Amendments are used to add, remove, or amend certain authorizations within the approved waiver. States with existing 1115 demonstration waivers can submit new proposals through an amendment application to update their underlying 1115 waiver. This allows states to make programmatic changes and test new and innovative ways to deliver and pay for health care services. Prior to submitting an amendment request to CMS, the state must conduct a comment period and hold two public hearings to give members of the public and tribal contacts the opportunity to provide feedback on the proposed changes. Amendments are then submitted to CMS for approval. Since its original approval in 1997, the 1115 Waiver has been amended numerous times and NY will continue to propose new amendments to address the evolving needs of New Yorkers.

See below for a full index of 1115 Waiver Amendments.

Implementation Status Key: Approved Pending Approval On Hold / Expired
CMS Submission Date Implementation Amendment Name Summary Approval
6/10/2024 Continuous Medicaid and Child Health Plus Eligibility for Children up to Age Six Intended to support consistent coverage and continuity of care by keeping children in Medicaid and Child Health Plus under the age of six continuously enrolled in health coverage, regardless of changes in circumstances that would otherwise cause a loss of eligibility or other changes that would affect eligibility. 11/14/2024
12/21/2022 IMD Transformation Demonstration Program This amendment provides the State with authority to provide high-quality, clinically appropriate treatment to beneficiaries with Substance Use Disorder (SUD) while they are short-term residents in residential and inpatient treatment settings that qualify as an IMD. The amendment also supports efforts to enhance provider capacity, improve the availability of Medication Assisted Treatment (MAT) and improve access to a continuum of SUD evidence-based services at varied levels of intensity, including withdrawal management services. 1/9/2024
9/2/2022 New York Health Equity Reform (NYHER): Making Targeted, Evidence-Based Investments to Address the Health Disparities Exacerbated by the COVID-19 Pandemic The overall goal of the NYHER waiver amendment is to advance health equity, reduce health disparities, and support the delivery of social care. NY seeks to build on the investments, achievements, and lessons learned from past 1115 waivers to scale delivery system transformation, improve population health and quality, deepen integration across the delivery system, and advance health-related social need (HRSN) services. 1/9/2024
6/8/2022 Reasonable Opportunity Period (ROP) Extension COVID-19 Public Health Emergency (PHE) Amendment This amendment will test, in the context of the COVID-19 PHE unwinding period, how the expenditure authority to provide coverage beyond the statutorily limited 90-day ROP for individuals who have declared to U.S. citizenship, but for whom that status has not been verified, will support state's management of workload during the unwinding period in a manner that promotes continuity of coverage and reduces barriers to care, in line with the objectives of the Medicaid program 10/28/2022
12/7/2021 Managed Care Risk Mitigation COVID-19 Public Health Emergency (PHE) Amendment This amendment would test whether, in the context of the current COVID-19 PHE, an exemption from the regulatory prohibition in 42 CFR § 438.6(b)(1) promotes the objectives of Medicaid. 1/18/2022
11/10/2020 Managed Long Term Care Plan Eligibility and Voluntary Mainstream Enrollment for Certain Dual Eligibles This amendment seeks to: (1) Permit dually eligible Medicare/Medicaid members who do not need Community Based Long-Term Care (CBLTC), and who voluntarily sign up for a Medicare Dual Eligible Special Needs plan with a qualified Mainstream Medicaid Managed Care (MMMC) plan, to stay enrolled in that MMMC plan and; (2) Modify the eligibility criteria for MLTC plans. The state received approval for the first component with the extension request approved by CMS on March 23, 2022. On October 31, 2024, CMS provided guidance on the second component, advising that section 1115 authority is not required for states to impose medical necessity or level of care requirements, and NYS can move forward without an amendment to the 1115 demonstration. Component 1: 03/23/2022 (per 1115 Extension Req)
Component 2: No Approval Req