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Research and Demonstration Project Waiver

HCBS Authority: 
Applicable CFR Sections: 
42 CFR §431.412

Authorizes the DHHS Secretary to consider and approve experimental, pilot or demonstration projects likely to assist in promoting the objectives of the Medicaid statute.

Medicaid Requirements That May Be Waived: 

DHHS Secretary may waive multiple requirements under §1902 of the Social Security Act if waivers promote the objectives of Medicaid law and intent of the program.

Application Process: 

Standardized Application (PDF) (must be approved by CMS and an External Federal Review Team; CMS readiness review site visit required)

Required Public Input Process (PDF)

Approval Duration: 

Initial application: 5 years

Renewal: 5 years


Monthly progress calls, quarterly and annual progress reports.

Administration & Operation: 

Administered by the Single State Medicaid Agency (SSMA).

May be operated by other entities as approved by CMS.

Provider Agreements: 

Not required.

Medicaid Eligibility: 

State defines eligible categories and may expand eligibility. Not intended to add new Medicaid eligibility group(s).

Other Eligibility Criteria: 

State determines requirements for services.

Public Input: 

Effective 4/27/12, the ACA requires States to develop a process that ensures transparency and public notice.

Information about the process can be found in the State Medicaid Director Letter 12-001 dated 4/2 7/12 (PDF) and at:

42 CFR §431.408

Target Groups: 

State determines target groups and defines eligibility criteria.

Other Unique Requirements: 

State must operate under an approved Operations Protocol.

Requires public input.

Case Management: 

Conflict of interest requirements may apply in terms and conditions.

Limits on Numbers Served: 

State estimates numbers served.

Operates as an entitlement to all who are eligible.

Waiting Lists: 
Not applicable.
Combining Service Populations: 
States may combine service populations.
Caps on Individual Resource Allocations or Budgets: 
Budget neutrality must be maintained. Caps or benefit limits may apply.
Allowable Services: 

State decides what services are covered, subject to CMS approval.

Allowable Participant Settings: 

HCB settings rules apply as part of terms and conditions

Regulations and CMS Guidance

Provider Qualifications: 

Determined by state, subject to CMS approval.

Participant-directed Services: 
Hiring of Legally Responsible Individuals: 
Allowed at the State’s discretion.
Cash Payments to Participants: 
Direct cash payments are permitted.
Financial Management Services: 

Required if participant direction is offered. May be a demonstration service or an administrative function.

Goods and Services: 
Permitted as a service.
Direct Payment of Providers: 

Not required.

Provider Payments: 

Payments for allowable services may be paid prospectively (before the service is provided).

Cost Requirements: 


Services cannot in aggregate cost more than without the §1115 waiver.

Quality Management: 

Extensive data collection and evaluation plans to assess the effectiveness of the project or demonstration.

Interaction with State Plan Services, Waivers & Amendments: 

State defines relationship to state plan, waivers, and amendments, subject to CMS approval.