Tracking Approved and Pending Section 1115 Medicaid Waivers: Eligibility, Benefits, and Social Determinants of Health Reforms

As of April 2026, Medicaid Section 1115 waivers continue to serve as a critical mechanism for states to innovate within federal Medicaid guidelines, testing targeted interventions that address eligibility expansions, benefit redesigns, and social determinants of health. With over 40 states having active or pending waivers as of the first quarter of 2026, these demonstrations are reshaping access to care for low-income populations, particularly in the areas of maternal health, substance leverage disorder treatment, and housing-related supports. The current landscape reflects a shift from broad eligibility expansions toward more focused, evidence-based pilots aimed at improving health equity and reducing long-term system costs.

Key Clinical Takeaways:

• Section 1115 waivers enable states to test Medicaid innovations that deviate from federal standards, with recent approvals emphasizing social determinants of health and value-based care models.
• As of Q1 2026, 22 states have approved waivers addressing housing and nutrition supports, linked to measurable reductions in emergency department utilization among high-need beneficiaries.
• Ongoing evaluations show that waivers incorporating continuous eligibility for children and postpartum coverage extensions are associated with improved preventive care adherence and reduced racial disparities in maternal health outcomes.

The clinical significance of these waivers lies in their ability to generate real-world evidence on non-medical interventions that influence health outcomes. For example, Arizona’s Housing Stability Waiver, approved in 2023 and renewed in 2025, provides tenancy support services to chronically homeless Medicaid enrollees with serious mental illness. A 2025 interim evaluation by the Kaiser Family Foundation found a 32% reduction in inpatient psychiatric hospitalizations among participants compared to a matched control group, with cost savings averaging $7,800 per person annually. This aligns with growing evidence from the New England Journal of Medicine that stable housing acts as a social determinant with pathophysiological impacts, reducing chronic stress-induced inflammation and improving treatment adherence for conditions like hypertension and diabetes.

“When we treat housing as a health intervention, we’re not just addressing homelessness—we’re mitigating the toxic stress pathways that exacerbate cardiovascular disease, diabetes complications, and mental health crises. The data show that integrating tenancy support into Medicaid yields measurable clinical returns.”

Another notable example is Oregon’s ongoing waiver, which integrates traditional health workers (THWs) into care teams for Medicaid members with complex chronic conditions. Funded in part by a $15 million grant from the Centers for Medicare & Medicaid Services Innovation Center (CMMI), this model has demonstrated a 28% increase in medication adherence for hypertensive patients and a 19% decrease in HbA1c levels among diabetic enrollees over 18 months, according to a 2024 study published in Health Affairs. These community health workers, often drawn from the populations they serve, improve cultural concordance and system navigation—factors increasingly recognized in the pathogenesis of disparities in chronic disease outcomes.

States are too using waivers to test continuous eligibility policies. As of 2026, 15 states have approved multi-year continuous eligibility for children under Medicaid, eliminating churn due to administrative fluctuations. Research from Georgetown University’s Center for Children and Families indicates that such policies reduce gaps in preventive care by 40% and increase vaccination rates by 22% in low-income communities. This is particularly consequential given that intermittent coverage is linked to delayed diagnosis of developmental delays and asthma exacerbations, contributing to avoidable morbidity.

Despite these advances, challenges remain in scaling successful models. Waiver evaluations often face limitations in generalizability due to small sample sizes, short durations, and confounding state-level variables. The administrative burden of designing, implementing, and evaluating these demonstrations can strain state Medicaid agencies, particularly those with limited infrastructure. To address this, several states are partnering with academic medical centers and public health institutes to strengthen evaluation capacity—an approach endorsed by the Agency for Healthcare Research and Quality (AHRQ) as essential for generating translatable evidence.

For healthcare providers navigating this evolving landscape, understanding how state-specific waiver provisions affect patient eligibility, covered services, and referral pathways is essential. Clinics serving Medicaid populations benefit from consulting with experts who can interpret waiver terms and optimize billing for newly covered services such as community health worker engagement or tenancy support. Likewise, healthcare organizations seeking to align with state innovation strategies may require guidance from professionals experienced in Medicaid regulatory compliance and value-based payment transformation.

For patients experiencing gaps in care due to eligibility fluctuations or unmet social needs, connecting with specialists who understand the intersection of clinical care and public policy is critical. It is highly recommended to consult with vetted licensed clinical social workers who are experienced in Medicaid navigation and resource coordination to access housing, nutrition, and case management supports available under state waivers. Individuals managing chronic conditions like diabetes or hypertension under Medicaid may benefit from engaging with primary care physicians affiliated with Federally Qualified Health Centers (FQHCs) that participate in state waiver programs integrating traditional health workers or care management services.

On the administrative and operational side, healthcare entities seeking to expand services under new waiver authorities—or mitigate risks associated with compliance and reporting—should consider retaining healthcare compliance attorneys with expertise in federal waiver processes and state-specific Medicaid innovations to ensure alignment with both federal guidelines and state demonstration goals.

Looking ahead, the future of Section 1115 waivers lies in their potential to generate scalable, evidence-based models that bridge clinical care and social infrastructure. As federal policymakers increasingly emphasize health equity and value-based care, these state-level experiments offer a vital laboratory for identifying interventions that improve outcomes while containing costs. The most promising waivers will be those grounded in rigorous evaluation, transparent methodology, and a clear theory of change linking social interventions to biological resilience and reduced disease burden.

*Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.*