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This document outlines the Special Terms and Conditions (STCs) for New York's Partnership Plan section 1115(a) Medicaid Demonstration extension, detailing federal involvement and state obligations
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How to fill out Partnership Plan Medicaid Section 1115 Demonstration

01
Gather all necessary documents required for the application.
02
Review the guidelines for the Partnership Plan Medicaid Section 1115 Demonstration.
03
Identify your target population and ensure eligibility criteria are met.
04
Outline the specific services and benefits to be included in the plan.
05
Develop a budget that aligns with the proposal's objectives and funding requirements.
06
Create a timeline for implementation and measure progress.
07
Submit the completed application through the designated portal.
08
Prepare for any follow-up inquiries or requests for additional information.

Who needs Partnership Plan Medicaid Section 1115 Demonstration?

01
Individuals who are low-income and require access to healthcare services.
02
Communities seeking improved healthcare delivery systems.
03
Organizations looking to implement innovative service delivery models.
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Authority & Purpose. Under Section 1115 of the Social Security Act, the Secretary of Health and Human Services (HHS) can waive certain federal Medicaid requirements. In addition, the Secretary may permit states to use federal Medicaid funds in ways that are not otherwise allowed.
Each §1115 waiver includes a list of Special Terms and Conditions (STCs) that detail the budget neutrality of the demonstration, the extent of federal involvement in the demonstration, and the evaluation process for determining the demonstration's spending and enrollment.
An 1115 waiver is a “Demonstration Project” waiver. “1115” is the section of the Social Security Act that outlines the purposes and limitations of these waivers. A 1332 waiver is an “innovation waiver.” It allows states to waive certain federal requirements for private insurance and marketplace coverage.
Section 1115 demonstrations and waiver authorities in section 1915 of the Social Security Act are vehicles states can use to test new or existing ways to deliver and pay for health care services in Medicaid and the Children's Health Insurance Program (CHIP).
The 1115 waiver, also known as the MRT Waiver in New York State, is an agreement between the federal Centers for Medicare and Medicaid Services (CMS) and New York State that allows the State to use a managed care delivery system to deliver benefits to Medicaid recipients, create efficiencies in the Medicaid program,
Each §1115 waiver includes a list of Special Terms and Conditions (STCs) that detail the budget neutrality of the demonstration, the extent of federal involvement in the demonstration, and the evaluation process for determining the demonstration's spending and enrollment.
New York State Medicaid received approval for its Medicaid 1115 waiver from the Centers for Medicare and Medicaid Services to improve the overall quality and health outcomes of New Yorkers. The waiver includes an investment of $7 billion statewide over a three-year period through March 2027.
Section 1115 Benefit Changes - Select Benefit Expansions Waiver Provision# of States with Approved Waiver Behavioral Health & Other Community-Based Benefit Expansions* Approved: 24 States (AK, AR, AZ, CA, DE, FL, HI, IL, KS, KY, MA, MD, ME, MT, NC, NJ, NM, NY, OR, RI, VA, VT, WA, WV)2 more rows • May 2, 2025

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The Partnership Plan Medicaid Section 1115 Demonstration is a program that allows state Medicaid programs to test new approaches in Medicaid that improve care for beneficiaries while reducing costs.
States seeking to implement innovative Medicaid programs or modifications to existing programs are required to file for the Partnership Plan Medicaid Section 1115 Demonstration.
To fill out the Partnership Plan Medicaid Section 1115 Demonstration, states must complete a comprehensive application that outlines the proposed program changes, implementation plan, evaluation strategies, and budget considerations.
The purpose of the Partnership Plan Medicaid Section 1115 Demonstration is to allow states flexibility in demonstrating new methods for delivering and financing Medicaid services, with the aim of enhancing quality of care and promoting cost-effective solutions.
States must report data on costs, enrollment figures, service utilization, quality measures, and the impact of the demonstration project on health outcomes and access to care.
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