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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 (2025-11-24)

In 2025, Medicaid waiver policies continue to evolve rapidly, with states leveraging Section 1115 waivers to tailor health coverage programs to their populations' needs. According to the latest KFF (Kaiser Family Foundation) tracker, numerous states have approved or pending waivers that aim to expand access, introduce work requirements, or modify benefit structures. These waivers are critical tools for states seeking flexibility within federal Medicaid rules, especially amid ongoing debates over health equity and cost containment. As of November 2025, over 30 states have active waivers, with several new applications under review, reflecting a dynamic landscape influenced by federal policy shifts and state-level health priorities. Recent developments include increased approval of waivers that incorporate innovative models like Medicaid managed care expansion, telehealth integration, and targeted outreach to underserved communities. Notably, states such as Arizona, Arkansas, and Ohio have recently secured approvals for waivers that emphasize workforce participation and community-based services, aligning with broader efforts to address social determinants of health. Meanwhile, pending applications from states like Florida and Texas signal ongoing negotiations around work requirements and Medicaid work incentives, which remain contentious topics in health policy debates. Beyond the immediate policy implications, these waivers are shaping the future of Medicaid by testing new approaches to coverage and delivery. For example, some states are experimenting with "block grants" or per capita caps, which could fundamentally alter federal-state funding dynamics. Additionally, recent federal guidance has clarified the criteria for approving waivers that promote health equity, emphasizing the importance of addressing disparities among racial and ethnic minorities, rural populations, and individuals with disabilities. In the broader context, Medicaid waivers are also intersecting with other health initiatives, such as the expansion of mental health services, integration of substance use disorder treatments, and efforts to improve maternal health outcomes. The ongoing evolution of these waivers reflects a national shift toward more personalized, flexible, and innovative Medicaid programs, aiming to improve health outcomes while managing costs. Recent facts that deepen understanding of this landscape include: 1. The Biden administration has approved over 20 new Medicaid waivers since 2023, emphasizing health equity and innovative care models. 2. Several states are exploring waivers that incorporate digital health tools, including AI-driven patient monitoring and telehealth expansion, to improve access in rural areas. 3. Federal funding for Medicaid innovation grants has increased by 15% in 2025, supporting states' efforts to pilot new waiver programs. 4. The Supreme Court is expected to hear cases challenging work requirement waivers, which could impact future approvals and policy directions. 5. Data shows that states with approved waivers focusing on social determinants of health have seen measurable reductions in hospital readmissions and disparities in care. As Medicaid continues to be a cornerstone of American health policy, understanding the approval process, pending applications, and the strategic goals behind these waivers is essential for policymakers, providers, and beneficiaries alike. The evolving landscape promises both opportunities and challenges in ensuring equitable, sustainable, and innovative health coverage for all Americans.

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