Association for Public Policy Analysis & Management

Purpose: Section 1115 waivers have the potential to foster innovative approaches to addressing access to healthcare among low-income populations by granting states increased autonomy in how they manage their Medicaid programs. The objective of this analysis is to evaluate how the use of a Section 1115 waiver was associated with Medicaid coverage compared to Medicaid expansion states that did not use a waiver.

Methods: Difference in difference analysis was conducted of adults aged 19–64 with family incomes at or below 138% of the federal poverty level from the 2010-2017 American Community Survey. Medicaid waiver states (Arkansas and Indiana) were compared to states that expanded without a waiver in calendar year 2014. The outcome measure was Medicaid coverage. The control variables were age, sex, marital status, number of children, poverty status, race/ethnicity, education, employment status, immigration status, and metropolitan residence.

Results: Arkansas’s use of a waiver to expand Medicaid was associated with a higher Medicaid coverage rate (2.3%, p< 0.001) compared to states that expanded Medicaid in 2014 without a waiver. In contrast, Indiana’s use of a waiver to expand Medicaid was associated with a lower Medicaid coverage rate (-3.5%, p<.001) compared to states that expanded Medicaid without a waiver.

Conclusion: The differences in findings between Indiana and Arkansas are likely related to differences in timing and implementation of Medicaid expansion.