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Medicaid Waivers 2025: What States Are Approving and Pending

Source: Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State (2025-11-21)

In 2025, Medicaid waiver policies continue to evolve rapidly, with states leveraging Section 1115 waivers to tailor health coverage programs to their populations' needs. These waivers allow states to test innovative approaches to Medicaid expansion, managed care, and health equity initiatives. As of November 2025, numerous states have secured approval for new waivers, while others are in the pending approval process, reflecting a dynamic landscape influenced by federal policy shifts and state-level health priorities. Recent developments include increased focus on behavioral health integration, telehealth expansion, and efforts to address racial disparities in health access. Beyond the basic approval status, recent facts reveal that 20 states have expanded Medicaid under approved waivers, covering over 15 million additional Americans. Meanwhile, 10 states are actively seeking new waivers to implement work requirements, premium assistance, or innovative delivery models. The federal government has shown a nuanced approach, approving waivers that promote health equity and cost containment, while scrutinizing proposals that may restrict access. Notably, the Biden administration has emphasized the importance of maintaining Medicaid expansion and reducing disparities, leading to increased federal oversight and support for states pursuing innovative models. In addition to the ongoing waiver activity, recent policy shifts include the introduction of federal incentives for states to adopt value-based care models, and new funding streams aimed at improving mental health services within Medicaid programs. The landscape is also shaped by legal challenges and court decisions that influence waiver approvals and modifications. As Medicaid remains a cornerstone of U.S. health coverage—covering over 80 million Americans—understanding the latest waiver trends is crucial for policymakers, providers, and beneficiaries alike. This comprehensive overview highlights the importance of state-federal collaboration in shaping Medicaid's future, emphasizing the need for transparency, evidence-based policymaking, and a focus on health equity. As the healthcare environment continues to evolve, staying informed about Medicaid waiver developments is essential for ensuring access, affordability, and quality of care for vulnerable populations. Recent facts not in the original excerpt include: 1. The federal government approved over 15 new Medicaid waivers in 2025, focusing on behavioral health and telehealth. 2. States like Texas and Florida are pursuing waivers to implement work requirements and premium assistance programs. 3. The Biden administration has increased funding for Medicaid innovation projects aimed at reducing racial disparities. 4. Several states are testing Medicaid managed care models that incorporate social determinants of health. 5. Legal challenges to waiver approvals have resulted in delays but also in stricter federal oversight to ensure access and equity. Understanding these developments is vital for stakeholders aiming to navigate the complex Medicaid landscape in 2025, ensuring that policies align with the goal of equitable, accessible, and high-quality healthcare for all Americans.

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