Notice on Rhode Island’s Medicaid 1115 Demonstration Waiver

Rhode Island’s current Medicaid 1115 Demonstration Waiver will expire on December 31, 2023. In December 2022, the Rhode Island Executive Office of Health and Human Services (EOHHS) submitted a Waiver Request to replace the current waiver as of January 1, 2024.

On a recent phone call with EOHHS, staff from the Center for Medicare and Medicaid Services (CMS) explained that – due to a very high volume of waiver submissions from states – it is not possible for CMS to approve Rhode Island’s waiver request by the end of calendar year 2023. For that reason, CMS intends to issue a 12-month extension of Rhode Island’s current 1115 waiver, which will maintain our current authorities but will not include new requests from our most recent waiver submission. This means that Rhode Island’s new waiver may not go into effect until January 1, 2025. It is possible that the new waiver may go into effect earlier than January 2025, but we do not have an estimate from CMS at this time.

CMS agreed to consider earlier approval for certain requests. This includes retaining certain home and community-based service authorities granted during the public health emergency (e.g., authority to reimburse parents of adult beneficiaries in Self-Direction) and changing the education requirement for home stabilization providers. EOHHS is working closely with CMS to try to get approval for these items by the end of 2023.

To implement any new waiver services that could affect state Medicaid spending – such as new housing supports, medical respite, or pre-release Medicaid – EOHHS requires state budget authority. EOHHS will make decisions on the inclusion of decision packages to request funding for these in the agency’s SFY25 budget submission on the same basis as before the change in waiver approval timing.

State budget authority will allow EOHHS to begin implementation no earlier than July 1, 2024. Even with CMS approval likely delayed until January 2025, the delay in implementation timing (due to the CMS delay) would be at most six months. In addition, EOHHS will use any time after budget approval and before CMS approval to prepare for implementation, which will further reduce the impact of the delay.

If you have any questions about Rhode Island’s 1115 waiver, please contact Medicaid Policy Director Amy Katzen at