Section 1115 Waivers

• Federal Policy Impacts
• Medi-Cal Eligibility
• Medi-Cal Benefits
• Behavioral Health
• Reproductive Health
• Medi-Cal Financing
• Section 1115 Waivers

For over two decades, California has used Section 1115 waivers to test innovative approaches in Medi-Cal, supporting person-centered reforms like California Advancing and Innovating Medi-Cal (CalAIM).  These waivers must be reviewed and approved by the federal Centers for Medicare and Medicaid Services (CMS). 

Notable Federal Actions 

• Ending Continuous Eligibility
  • In July 2025, CMS announced it will no longer approve or extend waivers for continuous eligibility beyond statutory requirements.  
• Concluding Workforce Initiatives 
  • In July 2025, CMS issued notice that it will no longer approve or extend existing workforce-related Section 1115 components, such as student loan repayment and workforce training programs, impacting California’s BH-CONNECT Section 1115 waiver workforce programs. California does not expect the workforce initiatives in BH-CONNECT to be renewed.  
• Rescinding Designated State Health Program Authority 
  • In April 2025, CMS announced it will no longer approve or renew expenditure authority for Designated State Health Programs, affecting CalAIM and BH-CONNECT waivers.  
• Revoking Health-Related Social Needs Services Guidance 
  • In March 2025, CMS rescinded previous guidance on covering services and supports that address health-related social needs under Section 1115 waivers. Existing approvals, including CalAIM and BH-CONNECT, remain in effect.  

Actions California Is Taking  

• CalAIM Waivers 
  • CMS approved California’s CalAIM Section 1115 waiver and complementary CalAIM Section 1915(b) waiver through December 2026. DHCS submitted to CMS a five-year renewal request for the CalAIM Section 1115 demonstration on May 12, 2026 and plans to submit a five-year renewal request for the CalAIM 1915(b) waiver in Quarter 3 2026. The requests were informed by the Continuing the Transformation of Medi-Cal Concept Paper, which was released in July 2025, and stakeholder input received during the 30-day public and Tribal comment periods.
  • DHCS reaffirmed that Medi-Cal’s Community Supports, authorized under CalAIM, remain unaffected and will continue operating and providing critical services to Medi-Cal members. 
• BH-CONNECT Waiver 
  • Approved through December 2029, BH-CONNECT expands access to community-based behavioral health services and includes Transitional Rent for eligible members experiencing or at risk of homelessness.
• Enhanced Care Management 
  • Enhanced Care Management does not require waiver authority to continue as a managed care plan benefit and therefore will be maintained. 

Page last updated July 1, 2026