Addressing health-related social needs through Medicaid Section 1115 Waivers: Challenges and opportunities

Key points:

• Over the course of the past four presidential administrations, the use of Medicaid 1115 waivers to address beneficiary health-related social needs has grown. At this time, twenty-five waiver projects are in progress, most of which were approved during the Biden administration.
• The most common target population for the current waiver projects is beneficiaries at high risk for or currently experiencing homelessness, in combination with a qualifying medical or behavioral health condition. The services addressing social needs being provided through these projects most commonly include supportive housing, nutrition supports, employment supports, and medical respite care.
• In 2025, the Trump administration rescinded prior Centers for Medicare and Medicaid Services guidance regarding social needs 1115 waivers, announced that 1115 waivers may no longer include employment supports or job training, and issued an executive order prohibiting federal support for “housing first” programs, essentially putting the use of 1115 waivers to address health-related social needs on pause.
• Although there are myriad policy and technical challenges associated with the rigorous evaluation and budget neutrality expectations of 1115 waivers, evidence-based social needs waiver demonstrations have the potential to both effectively and efficiently improve health in state Medicaid populations.