While most states expanding their Medicaid programs in response to the opportunity presented by the Affordable Care Act simply expand their existing Medicaid programs, six states have taken a different approach, obtaining Medicaid demonstration waivers so they could tailor their programs in different ways.

In addition, a number of states currently considering Medicaid expansion appear to be considering pursuing demonstration waivers, often referred to as section 1115 waivers, as well.

One area in which these demonstration programs differ from traditional Medicaid expansion is in the degree of financial responsibility new Medicaid beneficiaries assume. Typically, new Medicaid participants must pay more for the benefits they receive under their states’ Medicaid expansion through greater cost-sharing responsibilities.

In the new issue brief “How Will Section 1115 Medicaid Expansion Demonstrations Inform Federal Policy?” the Commonwealth Fund looks at the alternative approaches different states have taken and considers the implications of those different approaches for both beneficiaries and the states. Find that issue brief here.