DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
Center for Medicaid and CHIP Services
 
 
  
May 22, 2012 
 
Medicaid/CHIP Affordable Care Act Implementation 
Answers to Frequently Asked Questions 
 
Section 1115 Waiver Transitions 
Q1:  Will section 1115 demonstrations continue beyond December 31, 2013? 
A: The section 1115 waiver authority continues and whether a particular waiver continues will 
vary by State.  CMS has been working with States individually to determine the appropriate 
waivers and expenditure authorities that will be extended beyond December 31, 2013.  For 
example, States that have utilized demonstrations to expand eligibility to the childless adult 
population will no longer need the expenditure authority because this population will become a 
mandatory State plan population under the Affordable Care Acts Medicaid eligibility expansion.  
On the other hand, States that have utilized demonstrations to undertake delivery system reforms 
may still require waivers and/or expenditure authorities to execute those reforms beyond 
December 31, 2013. 
 
CMS will work with States to develop and submit the transition plans that are required by the 
Special Terms and Conditions of each demonstration.  These transition plans will serve as a 
vehicle for discussion of the various options that States will have in 2014 and beyond, including 
for populations with incomes above 133 percent of the Federal poverty level (FPL).  CMS will 
engage with States during State Operations and Technical Assistance (SOTA) calls to work 
through State-specific transition issues.   
 
Q2:  Many State demonstrations require that a transition plan to 2014 be submitted by a 
specified date, in many cases by July 1, 2012. Will CMS provide guidance and technical 
assistance before then?  What specifically is required to be included in the transition plan? 
A:  CMS plans to provide technical assistance on transition plans to States through the State 
Operations and Technical Assistance Team (SOTA) calls and through other calls with the State.  
We will also be providing additional guidance about the information that should be included in 
the transition plans.  We will consider the transition plans that need to be submitted by the due 
date as living documents that are open to revision, and will continue to work with States to 
ensure a seamless transition in 2014 for beneficiaries and States. 
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Q3:  Can the State Operations and Technical Assistance Team (SOTA) calls replace the 
requirement for submitting an 1115 transition plan? 
A:  The SOTA calls cannot replace the submission of a transition plan, as the plan is a required 
deliverable under the States Special Terms and Conditions.  However, we expect to use the 
SOTA calls as a platform for transition planning discussions.  We are also available for 
additional calls with States as needed.  We can accept as the States required early deliverable, a 
summary of the issues that the State needs to address in the transition plan, given the specific 
features of its waiver and plans for 2014.  We will work with States in subsequent months to 
fully develop the transition plan to ensure it is in place in time for 2014.  
 
Q4:  If a States demonstration is expiring in 2012, can the State request an extension? 
A:  Yes.   CMS will continue to consider section 1115 demonstration extension requests.  
However, the States proposal must include a plan to address changes in its demonstration that 
would need to take place to ensure readiness for 2014.  Please also note that extension requests 
are subject to the recently issued transparency final rule (http://www.gpo.gov/fdsys/pkg/FR-
2012-02-27/html/2012-4354.htm)and corresponding State Health Officials letter 
(http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SHO-12-001.pdf), which 
outlines the new public notice comment and process requirements.