While most states that took advantage of the Affordable Care Act to expand their Medicaid programs did so simply by expanding the population eligible to participate in the program, some expanded through the use of what are known as section 1115 waivers, which are defined as “experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs.”

Most of those waivers involve the use of new delivery systems, such as greater use of managed care, and six states implemented their Affordable Care Act Medicaid expansion through section 1115 waivers.

Why the alternative approach? While for some states it simply is a matter of trying new delivery systems, a recent post on the Health Affairs Blog suggests another motive:

These waivers are not clearly being sought because different states have different populations or demographics in need of different benefit packages. Rather, they are being sought for other reasons, because of the political concerns at work in many of these states, rhetoric around values including personal responsibility, and the desire to minimize additional spending on Medicaid populations.

The Health Affairs Blog post takes a closer look at what section 1115 waivers involve, why states use them instead of pursuing more traditional Medicaid expansion, and what the potential dangers of this mechanism might be. Go here to see its feature “Medicaid Expansion Through Section 1115 Waivers: Evaluating The Tradeoffs.”