Project 2025 Tracker / What’s done, what’s next

14. Department of Health and Human Services · Notable

Eliminate current Medicaid waiver and state plan processes

Not started

468 14. Department of Health and Human Services

“Eliminate current waiver and state plan processes. CMS should allow providers to make payment reforms without cumbersome waivers or state plan amendment processes where possible.”

What has happened

  1. Not started

    Congress moved the other way. Public Law 119-21 § 71118 adds a requirement to the Section 1115 process rather than removing one: from 2027-01-01 the Secretary may not approve, renew or amend a Medicaid demonstration unless the CMS Chief Actuary certifies it will not increase federal spending, and the section appropriates $5 million a year to administer the new certification. The state plan amendment process at 42 CFR part 430 is unchanged, and CMS published no rule letting providers make payment reforms outside it — the State directed payment proposal of 2026-05-22 would tighten that route, not open it.

Research log

What was searched, and what didn’t count as evidence

Research notes

  • Queries: Federal Register “state plan amendment” since 2025-01-20 → 10 documents (generic information-collection notices, the Idaho SPA 24-0015 hearing notice, the sex-rejecting-procedures rules, the State directed payment proposal, the community engagement rule); “section 1115 demonstration” → 8; a search of bill titles among those we keep and search, from congress.gov, for “waiver process” → 0.
  • The Idaho hearing notice (FR 2025-02938, 2025-02-24) is the only in-window record of a state plan amendment dispute; it concerns postpartum coverage for pregnancies ending in abortion and is a lead for the abortion asks, not for this one.
  • Regulatory agenda, checked 2026-09-01. Checked against the full HHS agenda on reginfo.gov (183 active RINs in the 2026 Unified Agenda, published 2026-08-14), not the abbreviated version the Federal Register prints. The nearest entry is recorded here; it does not name this ask’s object, so the Status is unchanged — an agenda entry that states a general goal in the ask’s subject area does not move the Status.
    • 0938-AW06, Strengthening the Integrity of Section 1115 Demonstrations (CMS-2412, Proposed Rule Stage, NPRM 01/2027), is the rulemaking that builds out the budget-neutrality certification Public Law 119-21 § 71118 added — the very requirement this item’s note records as Congress moving the other way. It is the opposite of eliminating the waiver process, and nothing in the 183 entries lets providers make payment reforms without a waiver or a state plan amendment.
Action
eliminate
Object
Medicaid waiver and state plan amendment processes
ID
1286