CMS Approves MA, OR Section 1115 Demonstration Initiatives

The Department of Health and Human Services (HHS) has approved two Medicaid section 1115 demonstration initiatives that aim to offer continuous coverage to children and seek to address social determinants of health needs in these states.

“This is an historic moment in our nation’s fight to end hunger and improve health equity, particularly in states like Oregon and Massachusetts,” said HHS Secretary Xavier Becerra.

“Groundbreaking action in each state will ensure children and youth remain connected to health care, and that we double down on tackling social needs impacting health, such as nutrition. Everyone should get the access to care they need to live safe and healthy lives.”

The initiatives were approved in Oregon and Massachusetts. One of the aims of these demonstrations is to maintain extensive Medicaid coverage. In Oregon, the demonstration will provide continuous enrollment for children who are eligible for Medicaid. Children who fall above the benchmark age will have Medicaid coverage for up to two years, regardless of their household’s income status.

“I’m proud to partner with Oregon and Massachusetts to improve quality and access, reduce health disparities, and improve health equity, for those who need it most. For the first time ever, children with Medicaid coverage in Oregon will be able to keep their coverage until the age of 6 — ensuring they can get the care they need during their formative years. This is just one aspect of the groundbreaking demonstration initiatives that I’m approving today,” said CMS Administrator Chiquita Brooks-LaSure.

In Massachusetts, adults and children will have up to a year of continuous coverage after being released from a correctional institution. Individuals without stable housing will be able to receive two years of continuous eligibility.

Additionally, the section 1115 demonstrations address social determinants of health challenges like food insecurity. The states will have the ability to enact pilots that offer benefits like nutritional support and housing supports.

Specifically, the Massachusetts plan will offer limited-time housing supports and food assistance for as long as a year, including additional meal benefits for children or pregnant women will special health needs. The state will also apply the Hospital Quality and Equity Initiative.

Similarly, Oregon plans to expand food support and housing support.

“These states are also partnering with community-based providers to address the root social causes of health concerns, like lack of access to nutritious food and housing insecurity. We applaud Massachusetts and Oregon for helping us use every tool available to protect and expand access to high-quality, comprehensive, affordable health care coverage,” said Administrator Brooks-LaSure.

Going forward, the states will report back to CMS on their progress and share the outcomes of these initiatives.

Some states are using section 1115 demonstration waivers to support individuals in the justice system. Oregon was among a handful of states that submitted a 1115 demonstration waiver to provide more support to Medicaid-eligible incarcerated individuals.

Experts have also argued that 1115 demonstration waivers can be useful in the drive toward health equity. There are at least four ways that these initiatives can enact change and impact the care of underserved populations.

Massachusetts and Oregon are among the states that have expanded their Medicaid programs. Experts have projected that total Medicaid expansion could make a significant impact on uninsurance and health equity.