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 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In March 2025, CMS rescinded previous guidance on covering services and supports that address health-related social needs under Section 1115 waivers.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. In July 2025, DHCS solicited feedback on the Continuing the Transformation of Medi-Cal Concept Paper.
To prepare for submitting its CalAIM Section 1115 demonstration renewal request, DHCS released a draft renewal proposal for public review. DHCS then held 30‑day public comment and Tribal comment periods from February 10, 2026, through March 12, 2026. During this time, DHCS presented and discussed the renewal request during two public hearings and two Tribal webinars.
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 April 22, 2026