Protect Programs. Preserve Services. Plan the Path Forward.
Section 1115 demonstrations (waivers) allow states to test innovative Medicaid and CHIP program models. When waivers expire or CMS changes expectations, organizations face complex transitions. Health Management Associates (HMA) provides end-to-end consulting, policy analysis, financial modeling, and operational support to help healthcare leaders navigate Section 1115 waiver transitions and CMS policy shifts smoothly, protecting programs and preserving critical services. We deliver tailored strategies across the Medicaid ecosystem:
State Medicaid Agencies
Evaluate policy, financing, and implementation options to navigate waiver transitions smoothly.
Managed Care Organizations
Assess benefit, contract, reimbursement, operational, and In Lieu of Services and Settings (ILOS) impacts.
Providers, Health Systems, and CBOs
Prepare hospitals, health systems, and community organizations for upcoming reimbursement and operational changes.
How HMA Supports 1115 Waiver Transition Planning
To help organizations reduce financial risk and sustain health-related social needs (HRSN) initiatives amid evolving CMS expectations, we provide integrated strategy, actuarial analysis, and operational implementation:
- Transition & Exposure Assessments: Identifying affected programs, populations, and funding streams to ensure smooth transitions.
- Alternative Pathway Analysis: Evaluating viability for Section 1915(b), 1915(c), 1915(i), or 1915(k) authorities, State Plan Amendments (SPAs), Health Homes, and In Lieu of Services and Settings (ILOS).
- Budget Neutrality & Financial Modeling: Assessing fiscal impacts, federal funding implications, and long-term sustainability scenarios.
- Program & Managed Care Redesign: Aligning benefit changes with care models, rate structures, network requirements, and quality strategies.
Proven 1115 Waiver Leadership & End-to-End Lifecycle Experience
HMA combines deep Medicaid policy insights from strategy through implementation to guide public and private sector organizations through complex waiver renewals:
- Multidisciplinary Public & Private Support: Our team brings together actuarial scientists, clinical operations experts, and managed care strategists to coordinate strategy across states, health plans, and providers.
- Full-Lifecycle Capability: We don’t just consult—our teams design demonstrations, lead CMS negotiations, manage complex renewals and amendments, and build long-term post-transition evaluation frameworks.
- Proven Track Record: Supported by top national Medicaid experts, we bring unmatched practical insight into CMS expectations and state-level operations.
Medicaid insights you can use.
With CMS evolving its expectations for 1115 demonstrations, HMA’s Medicaid experts provide the sharp policy analysis, actuarial modeling, and managed care strategy required to protect your programs and preserve critical community services.
Explore Our Latest InsightsWho provides Medicaid Section 1115 demonstration transition consulting?
HMA supports states, health plans, providers, and community organizations through Section 1115 waiver and demonstration transitions, from strategy and analysis through implementation.
What are the alternatives to Section 1115 demonstrations?
Common alternatives include Sections 1915(b), 1915(c), 1915(i), and 1915(k), state plan amendments, Health Homes, managed care approaches, In Lieu of Services (ILOS), Alternative Benefit Plans, and other Medicaid or non-Medicaid funding pathways.
Can programs transition from Section 1115 demonstrations to Section 1915 authorities?
Yes. In some cases, programs can transition from Section 1115 demonstrations to Section 1915 authorities or other Medicaid pathways, depending on the populations served, covered services, financing, operational requirements, and state priorities.
Can health-related social needs programs continue after changes to Section 1115 demonstrations?
Sometimes. Depending on the program, state priorities, and CMS guidance, health-related social needs initiatives may continue through managed care, In Lieu of Services (ILOS), Home and Community-Based Services, value-based care arrangements, or other financing approaches.
Explore Audience-Specific 1115 Transition Support
Different organizations face different 1115 transition challenges. Explore HMA’s audience-specific pages for deeper guidance tailored to state Medicaid agencies, managed care organizations, providers and community organizations.
- State Medicaid agencies: financing, policy, stakeholder alignment, and implementation planning. Explore State Support
- Managed care organizations: contracts, rates, ILOS strategy, and operational readiness. Explore Managed Care Support
- Providers and community organizations: reimbursement, service continuity, and implementation support. Explore Provider Support
Connect with HMA’s Medicaid consultants
for strategic guidance, policy analysis, and implementation support.
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