Tip for State-specific

Section 1115 waivers let states experiment with Medicaid — each state's program is different

Tip for State-specific

Some 1115 waivers expand Medicaid to populations not normally eligible (e.g., higher income adults)

Tip for State-specific

Check your state's specific 1115 waiver terms — some include work requirements or healthy behavior incentives

Medicaidhard

Section 1115 Demonstration Waiver Application

State-specific · State Medicaid Agencies (CMS approved)

Application for coverage under Section 1115 demonstration waivers that allow states to test new approaches such as community engagement requirements or substance use treatment.

Form Details

Total fields: 65
Auto-fillable: 30 (46%)
Time without BeneFill: 60 minutes
Time with BeneFill: 15 minutes
Time saved: 45 minutes
Filled by: patient
Frequency: one time
State-specific: Yes — form may vary by state

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Where to Submit This Form

🌐

Apply through your state Medicaid portal

Section 1115 waiver programs vary by state. Contact your state Medicaid agency for the correct application.

🏢

At your local Medicaid or Social Services office

📬

Mail to your state Medicaid agency

Required Attachments

📎 Standard Medicaid application documentation (identity, income, residency)
📎 Additional documentation specific to the 1115 waiver program (varies by state)
📎 Medical records if the waiver targets a specific health condition or population
📎 Work or community engagement documentation (if the waiver has such requirements)

Processing Time

Standard Medicaid processing times apply: up to 45 days (90 days for disability-related). Some 1115 waiver programs have additional processing steps.

What Happens Next

Your state will determine eligibility under the 1115 waiver criteria. These programs may offer expanded benefits, different eligibility rules, or innovative care delivery models not available under standard Medicaid.

Tips for This Form

✓ Section 1115 waivers let states experiment with Medicaid — each state's program is different
✓ Some 1115 waivers expand Medicaid to populations not normally eligible (e.g., higher income adults)
✓ Check your state's specific 1115 waiver terms — some include work requirements or healthy behavior incentives
✓ CMS maintains a list of approved 1115 waivers at medicaid.gov/section-1115-demonstrations

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State-specific · State Medicaid Agencies

Documents medical expenses applied toward meeting the spend-down amount. Once the difference between income and the medically needy income level is met, Medicaid covers remaining expenses.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Medicaid Agencies (CMS approved) or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.