My state wants to change its Medicaid program in some way—does it need a waiver to do that?
Maybe. States have a lot of flexibility to design their Medicaid programs within the limits established by federal law, so there are a lot of changes that states can make without a waiver. And the Deficit Reduction Act of 2006 (DRA) gives states even more authority to make changes to their Medicaid benefits packages and cost-sharing without seeking a waiver. So, the first thing to look for when your state is proposing a change to its Medicaid program is whether the change is allowable under federal law. If not, then the state would need to request a waiver from HHS to make that change. Sometimes, a state will request a waiver to do something that is allowed under federal Medicaid law, but it wants to establish firm cost controls or make other programmatic changes at the same time that require a waiver. For example, a state may expand coverage for the parents of children who are eligible for Medicaid without a waiver, but if it wants to give them a reduced benefit package, charge them h
