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TAXABLE YEAR 20 Request for Consent for a Waterside ReElection CALIFORNIA FORM 1115 Fill out the form completely. Do not change the method of filing until the Franchise Tax Board has approved this

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What is form 1115?

Form 1115 is used by states to request waivers for certain requirements under Medicaid, as part of the Section 1115 demonstration program.

Who is required to file form 1115?

State Medicaid agencies are required to file form 1115 in order to request waivers for their Medicaid programs.

How to fill out form 1115?

Form 1115 must be filled out with detailed information about the proposed waivers, including the goals, populations affected, and evaluation methods.

What is the purpose of form 1115?

The purpose of form 1115 is to allow states to experiment with innovative approaches to providing Medicaid services, with the goal of improving health outcomes and reducing costs.

What information must be reported on form 1115?

Form 1115 requires information on the proposed waivers, the expected impact on Medicaid beneficiaries, and the evaluation plan for assessing the success of the demonstration.

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