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

14. Department of Health and Human Services · Notable

Rescind Section 1115 waiver requirements for climate-related benefits

Partially done

469 14. Department of Health and Human Services

“This reform would include adding Section 1115 waiver requirements in some cases (such as imposing work requirements for able-bodied adults) while rescinding requirements in others (such as non–health care benefits and services related to climate change).”

What has happened

  1. Partially done

    CMS rescinded the framework. The CMCS Informational Bulletin *Rescission of Guidance on Health-Related Social Needs*, signed by the Deputy Administrator and Director of the Center for Medicaid and CHIP Services, was read in full on 2026-09-03: "CMS is rescinding the November 2023 and December 2024 CIBs. CMS will consider states' applications to cover these services and supports on a case-by-case basis … **without reference to the November 2023 and December 2024 CIBs or the HRSN Framework.**" The bulletin names the framework in terms, and medicaid.gov's own guidance index now labels both superseded bulletins "[RESCINDED ON MARCH 4, 2025]". That is the instrument under which States obtained Section 1115 authority for non-health-care benefits, withdrawn. **`partial` and not `done`, for two reasons.** (i) The Quote asks for rescission of "non–health care benefits and services **related to climate change**"; the bulletin rescinds the HRSN framework wholesale — housing, nutrition, utilities — and the word "climate" appears nowhere in it. That is §3's "achieved by other means": delivery of a piece by a broader instrument. (ii) The bulletin revokes no approved demonstration; it says CMS will judge future applications case by case, so existing HRSN authorities continue. A reviewer who reads the Quote's parenthetical as the whole ask could hold this at `attempted`; `partial` is recorded because the rescission is complete and immediate as to the framework itself. The congressional half of the same story stands unchanged: Public Law 119-21 § 71118 requires actuarial certification of budget neutrality for every Section 1115 demonstration from 2027-01-01, which is what paid for non-medical benefits. The work-requirement half of the same Quote is #1281 and is `done`.

Research log

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

Research notes

  • Queries: Federal Register “health-related social needs” since 2025-01-20 → 13 documents, all Medicare quality-measure rules removing health-equity and social-drivers-of-health measures (a different program); “section 1115 demonstration” → 8; cms.gov’s index of its own pages (145,119 URLs) searched for “health-related-social-needs” → one undated FAQ PDF.
  • medicaid.gov was once thought closed to us. It is not, and the bulletin, its landing page (medicaid.gov/federal-policy-guidance/2025-03-03/177006, same date, a stabler address if the PDF ever moves) and the live HRSN page were all read on 2026-09-03. The live HRSN page has been stripped back to two pre-2025 links — a 2021 SDOH State Health Official letter and a May 2024 homelessness bulletin — and the Framework is not linked from it.
  • Note on the PDF: cib03042025.pdf carries a stale template Title in its metadata (“CIB: 2020 Federal Poverty Level Standards”). Its body is unambiguous and dated March 4, 2025; the title field is an artifact of CMS’s template and not a sign of the wrong document.
  • HHS 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 did not change: an agenda entry counts as an attempt only when it names what the ask asks for.
    • 0938-AW06 (Strengthening the Integrity of Section 1115 Demonstrations, CMS-2412, NPRM 01/2027) is the only § 1115 rulemaking on the agenda, and it is about budget-neutrality certification under Public Law 119-21 § 71118. Nothing in the 183 entries rescinds the health-related social needs framework or § 1115 authority for housing, nutrition or climate-related benefits; “climate” and “health-related social needs” return 0.
Action
rescind
Object
Section 1115 waiver requirements for non–health care and climate-related benefits
ID
1287