State Medicaid 1115 Waivers

***NEW*** CMS has released guidance for states to apply for an 1115 Medicaid waiver to expand coverage for people living with HIV.  ***NEW***

Read the guidance here. 

Download and send a letter to your Medicaid Director here.

This page is a grassroots toolkit for HIV/AIDS advocates and their allies seeking to use the state Medicaid 1115 waiver option to expand early access to HIV care for low-income people living with HIV.  These materials were developed by the Treatment Access Expansion Project, Dose of Change, and the Coalition for a National AIDS Strategy.

States can use Medicaid 1115 waiver option as a strategy to:

  • Address the ongoing AIDS Drug Assistance Program crisis

  • Overcome widespread and deep state budget cuts by leveraging Federal matching dollars

  • Increase effectiveness of existing resources through promoting early intervention

  • Prepare and test implementation strategies before 2014 Medicaid expansion

Use this site to find out about upcoming training events, take action, and learn more.

Just what is an 1115 waiver, anyway?

Simply put, states may request permission from the federal government to use their federal Medicaid funds in creative ways to maximize the number of people who benefit from the program.  The federal application process is known as an “1115 waiver.”  Once approved, states may expand coverage to low-income people living with HIV who would otherwise not qualify for Medicaid. 

In fact, the President’s National HIV/AIDS Strategy calls on the Centers for Medicare and Medicaid Services (CMS) to “promote and support the development and expedient review of Medicaid 1115 waivers to allow States to expand their Medicaid programs to cover pre-disabled people living with HIV” by the end of 2010.

But why is this so important for people living with HIV?

Currently, there is a growing access-to-care crisis, and public health emergency, for low-income people living with HIV.  Thousands of people are currently on wait lists for help from their state’s AIDS Drug Assistance Program (ADAP), and even more face barriers gaining access to lifesaving anti-HIV medications because of ADAP cost-containment measures.  Without an immediate government response, the crisis will continue to grow.  While the health care reform law will expand Medicaid access for most low-income HIV-positive people, Medicaid expansion will not occur until 2014.  We cannot wait until 2014 for expanded HIV care options:  AIDS advocates must act now to ensure people living with HIV have a bridge to care until 2014 when new options become available.

These materials develop by the Treatment Access Expansion Project (, DOSE of CHANGE (, and the Coalition for a National AIDS Strategy (