Federal health care waivers

Federal waivers allow states to offer and test new ways to deliver and pay for health care services. The Minnesota Department of Human Services (DHS) has applied for or received approval of the following waivers from the federal Centers for Medicare & Medicaid Services (CMS).

Section 1115 waivers

Reentry waiver application
CMS announced an option in April 2023 allowing states to provide Medicaid covered services in correctional facilities under a section 1115(a) waiver of the Social Security Act. CMS stated that expanded access to services to people while incarcerated will improve health outcomes and reduce repeating offenders. Medicaid cannot be used to cover services in correctional facilities without a section 1115(a) waiver. The 2024 Minnesota legislature authorized DHS to request a waiver. State law identifies the services to be covered, the eligible populations, the correctional facilities included, and how public input will be sought. Refer to Minnesota Statutes, 256B.0761 for more information.

DHS, in collaboration with the Minnesota Department of Corrections (DOC), developed a Reentry waiver application that seeks to improve health outcomes, reduce deaths, decrease repeat offense rates, and address related disparities for people who have been incarcerated. Minnesota will provide a set of Medicaid covered services to eligible participants within 90 days of release to achieve these outcomes. The waiver application was posted for a 30-day public comment period and two public hearings were held in December 2024 to provide DHS with feedback about the application. The comments and feedback, and DHS’ responses, were included in the final application submitted to CMS on Jan. 16, 2025. The CMS review is pending, and CMS does not have a specific timeline to respond.

Reentry Waiver Documents

DHS submitted the Reentry waiver application, with the cost and enrollment projections, to CMS on Jan. 16, 2025.
- Minnesota Reentry Waiver Application (PDF) (submitted to CMS on Jan. 16, 2025)
- Cost and Enrollment Projections (XLSX) (submitted to CMS on Jan. 16, 2025, with the waiver application)
- Reentry Waiver Application Summary (PDF) (posted Nov. 25, 2024, as part of the documents for public comment)
Substance Use Disorder System Reform waiver
The Substance Use Disorder (SUD) waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) on Aug. 16, 2019, and is effective from July 1, 2019, through June 30, 2025. The SUD waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.

DHS submitted an extension request to CMS on Dec. 21, 2023, to continue the waiver for a five-year period beginning July 1, 2024. On May 30, 2024, CMS provided a temporary extension that continued the operational terms of the waiver through June 30, 2025. On June 18, 2025, CMS provided a second temporary extension through Sept. 30, 2025. On Sept. 18, 2025, CMS provided a third temporary extension through Oct. 31, 2025. The temporary extension of the waiver does not impact people receiving services or providers. DHS anticipates that CMS will complete its review of the waiver extension request (submitted in December 2023) during the third temporary extension period.

This demonstration project is an important component of the state’s larger reform effort to address the opioid crisis as well as transform the health care delivery system for Medicaid members who need substance use disorder treatment. The waiver authorizes federal Medicaid matching funds for residential programs that have been determined as Institutions for Mental Diseases. The demonstration waiver tests the impact of evidence-based provider referral arrangements and practices on improving health outcomes for Medicaid members with substance use conditions.

SUD Waiver Documents and Reports

Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and are specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.
- SUD waiver approval, expenditure and waiver authorities, and special terms and conditions (PDF) (received from CMS on Aug. 16, 2019)
- SUD Waiver Monitoring Protocol Part A (XLSX)
- SUD Waiver Monitoring Protocol Part B (PDF)
- SUD Waiver Extension Request (PDF) (submitted to CMS on Dec. 21, 2023)
- SUD Waiver Extension Request Summary (PDF) (posted Sept. 21, 2023, as part of the documents for public comment)
Design Plans and Evaluation Reports
- SUD Waiver Implementation Plan (PDF)
- SUD Waiver Evaluation Design Plan (PDF)
- SUD Waiver Mid-Point Assessment, Demonstration Year 2, March 2022 (PDF) (CMS-approved document with updates for accessibility)
- SUD Waiver Interim Evaluation Report, July 2024 (PDF)
Quarterly and Annual Reports

DHS posts reports as they are approved by CMS.

SUD Demonstration Year 1 (July 1, 2019-June 30, 2020)
- Report for Demonstration Year 1, Quarters 2 and 3 (PDF)
- Quarterly Report for Demonstration Year 1, Quarter 4 (PDF)
SUD Demonstration Year 2 (July 1, 2020-June 30, 2021)
SUD Demonstration Year 3 (July 1, 2021 - June 30, 2022)
- Quarterly Report for Demonstration Year 3, Quarter 1 (PDF)
- Quarterly Report for Demonstration Year 3, Quarter 2 (PDF) from the federal Medicaid website
- Quarterly Report for Demonstration Year 3, Quarter 3 (PDF) from the federal Medicaid website
- Quarterly Report for Demonstration Year 3, Quarter 4 (PDF) from the federal Medicaid website
SUD Demonstration Year 4 (July 1, 2022 - June 30, 2023)
- Quarterly Report for Demonstration Year 4, Quarter 1 (PDF) from the federal Medicaid website
- Quarterly Report for Demonstration Year 4, Quarter 2 (PDF) from the federal Medicaid website
- Quarterly Report for Demonstration Year 4, Quarter 3 (PDF) from the federal Medicaid website
- Quarterly Report for Demonstration Year 4, Quarter 4 (PDF) from the federal Medicaid website
SUD Demonstration Year 5 (July 1, 2023 - June 30, 2024)
SUD Demonstration Year 6 (July 1, 2024 - June 30, 2025)
- Quarterly Report for Demonstration Year 6, Quarter 1 (PDF)
Prepaid Medical Assistance Project Plus (PMAP+) waiver
The Prepaid Medical Assistance Project Plus (PMAP+) waiver was first approved by the Centers for Medicare & Medicaid Services (CMS) in July 1995. The PMAP+ waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.

On Nov. 15, 2023, CMS approved Minnesota’s request to extend the waiver from Jan. 1, 2024, through Dec. 31, 2028.

The PMAP+ waiver provides federal authority to:
- Cover children under Medical Assistance who are 12 to 23 months old with income eligibility above 275% and at or below 283% of the federal poverty level (FPL).
- Waive the federal requirement to redetermine the basis of Medical Assistance eligibility for caretaker adults with incomes at or below 133% of the FPL who live with children age 18 who are not full-time secondary school students.
- Provide Medical Assistance benefits to pregnant people during the period of presumptive eligibility.
- Provide continuous eligibility under Medical Assistance for children up to age six, and 12 months of continuous eligibility for children ages 19 and 20.
- Provide Medical Assistance to former foster care youth up to age 26.
PMAP+ Waiver Documents and Reports

Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and are specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.
- PMAP+ waiver approval, expenditure and waiver authorities, and special terms and conditions (PDF) (received from CMS on June 26, 2025)
- PMAP+ waiver approved extension request (PDF) (submitted to CMS on June 29, 2020) as published on the federal Medicaid website
- PMAP+ amendment for extended and expanded continuous Medicaid eligibility for children (PDF) (submitted to CMS on Jan. 25, 2024)
- PMAP+ amendment for former foster care youth (PDF) (submitted to CMS on Jan. 25, 2024)
Design Plans and Evaluation Reports
- Refer to Attachment C, PMAP+ Waiver Evaluation Plan for 2021-2025, of the Minnesota PMAP+ Section 1115 Waiver Extension Request (PDF) from the federal Medicaid website
- Refer to Attachment B, PMAP+ Waiver Interim Evaluation Report 2014-2018, of the Minnesota PMAP+ Section 1115 Waiver Extension Request (PDF) from the federal Medicaid website
- PMAP+ Waiver Final Summative Evaluation Report (Revised report is expected to be completed in June 2025)
- PMAP+ Waiver Reasonable Opportunity Period (ROP) Evaluation Design (PDF) from the federal Medicaid website
Quarterly and Annual Reports

DHS posts reports as they are approved by CMS. DHS archives reports from prior demonstration years. Email dhspfr.federalrelations@state.mn.us to request an archived report.

PMAP+ Demonstration Year 24 (July 1, 2018 - June 30, 2019)
- Quarterly reports for Demonstration Year 24 (PDF)
- Annual report for Demonstration Year 24 (PDF)
PMAP+ Demonstration Year 25 (July 1, 2019 - June 30, 2020)
PMAP+ Demonstration Year 26 (July 1, 2020 - June 30, 2021)
PMAP+ Demonstration Year 27 (July 1, 2021 – June 30, 2022)
PMAP+ Demonstration Year 28 (July 1, 2022 – June 30, 2023)
- Quarterly report 1 Demonstration Year 28 (PDF)
- Quarterly report 2 Demonstration Year 28 (PDF)
- Quarterly report 3 Demonstration Year 28 (PDF)
- Quarterly report 4 Demonstration Year 28 (PDF)
- Annual report for Demonstration Year 28 (PDF) from the federal Medicaid website
Reform waiver
The Reform waiver was first approved under the title “Reform 2020: Pathways to Independence” by the Centers for Medicare & Medicaid Services (CMS) on Oct. 18, 2013. The title was changed from “Reform 2020: Pathways to Independence” to “Reform: Pathways to Independence” as part of the extension request approved by CMS on Jan. 2, 2025. The Reform waiver is authorized under section 1115 of the Social Security Act as a demonstration waiver.

On Jan. 31, 2020, CMS approved Minnesota’s request to extend the Reform waiver through Jan. 31, 2025. DHS submitted an extension request to CMS on Aug. 2, 2024, to continue the waiver for a five-year period beginning Feb. 1, 2025. On Jan. 2, 2025, CMS approved Minnesota’s request to extend the waiver from Feb. 1, 2025, through Jan. 31, 2030.

The Reform waiver provides federal financial support for the Alternative Care program. This program provides home and community-based support to help older adults with lower income, who are at risk of nursing home placement, stay in their homes.

Reform Waiver Documents and Reports

Section 1115 waivers require DHS to submit monitoring and evaluation reports to CMS. These and other waiver requirements are in the special terms and conditions provided by CMS, and specific to each section 1115 waiver. The special terms and conditions specify the additional requirements and timelines for deliverables the state must meet.
- Reform waiver approval, expenditure and waiver authorities, and special terms and conditions (PDF) (received from CMS on Jan. 2, 2025) from the federal Medicaid website
- Reform waiver approved extension request (PDF) (submitted to CMS on Aug. 2, 2024) as published on the federal Medicaid website
- Reform waiver extension request summary (PDF) (posted May 31, 2024, as part of the documents for public comment)
Design Plans and Evaluation Reports
Quarterly and Annual Reports

DHS posts reports as they are approved by CMS. DHS archives reports from prior demonstration years. Email dhspfr.federalrelations@state.mn.us to request an archived report.

Reform 2020 Demonstration Year 7 (July 1, 2019 - June 30, 2020)
Reform 2020 Demonstration Year 8 (July 1, 2020 - June 30, 2021)
Reform 2020 Demonstration Year 9 (July 1, 2021 – June 30, 2022)
Reform 2020 Demonstration Year 10 (July 1, 2022 – June 30, 2023)
Reform 2020 Demonstration Year 11 (July 1, 2023 – June 30, 2024)
Reform 2020 Demonstration Year 12 (July 1, 2024 – June 30, 2025)
- Quarterly report 1 Demonstration Year 12 (PDF)
Public Hearings and Comments

This section includes information about the public comment process, requesting documents, comment periods and public forums.

Public comment process

Public comment periods for waivers are posted in this section. DHS must receive your comments by the posted deadline.

Email comments about waiver applications, amendments or extensions to Section1115WaiverComments@state.mn.us. DHS requests comments be submitted in Microsoft Word format or incorporated within the email text to support making comments available to people who use screen readers. If you would also like to provide a signed copy of a comment letter, you may submit a second copy in Adobe PDF format. Comments provided on paper or in an electronic format that cannot be converted for a screen reader may be reformatted to meet state accessibility requirements for posting. The original formatting and content will be kept as much as possible. For example, if graphics or tables are included, a description that can be read will be added. Comments received may be posted publicly.

Paper copies of applications, amendments and extensions are available by request. Email Section1115WaiverComments@state.mn.us to request a copy be mailed, or to pick up a copy. Mail your request or comments via the U.S. Postal Service to:

Minnesota Department of Human Services
Federal Relations – Medicaid Waivers
P.O. Box 64967
St. Paul, MN 55164-0967

Comment periods for waiver documents

Information about waiver documents available for review and comment is posted in this section in advance of submission to CMS.

No waiver documents are currently posted for public comment.

Comments for public forums

Information about participation in public forums is posted in this section in advance of the forum, and comments are taken during the forum.

No public forums are currently scheduled.

Section 1915(b) waivers

Minnesota Senior Care Plus (MSC+) waiver

The MSC+ waiver allows Minnesota to require seniors to enroll in managed care to receive Medicaid services. This includes people who are dually eligible for both Medicaid and Medicare and who have not opted to enroll in Minnesota Senior Health Options (MSHO). The MSC+ waiver operates in combination with Minnesota’s Elderly Waiver to enable the integration of community-based long-term care services into the managed care service delivery system. The waiver also provides federal authority to require certain populations eligible for Medical Assistance to enroll in managed care, including American Indians and children who are in foster care.

The current MSC+ waiver expires June 30, 2026. Review the MSC+ Waiver and CMS Approval letter (PDF) for more information.

DHS submitted a waiver amendment request to the Centers for Medicare and Medicaid Services (CMS) on Nov. 30, 2023, to add Community First Services and Supports (CFSS) to MSC+. CMS approved the amendment on Feb. 27, 2024, with an effective date of June 1, 2024. DHS submitted an amendment to CMS on June 13, 2024, to change the effective date of CFSS from June 1, 2024, to Oct. 1, 2024. There were no additional substantive revisions to the content of the waiver request approved by CMS on Feb. 27, 2024. Refer to the MSC+ waiver amendment (PDF) for a copy of the amendment request, and MSC+ budget neutrality spreadsheet for budget neutrality information.

DHS submitted a waiver amendment request to CMS on Sept. 23, 2025, to discontinue the housing stabilization services benefit provided in MSC+ effective Nov. 1, 2025. The public comment period was held from Aug. 21, 2025 to Sept. 20, 2025. Refer to the MSC+ waiver amendment (PDF) for a copy of the amendment request and budget neutrality spreadsheet submitted to CMS. Refer to the Housing Stabilization Services program termination FAQ webpage for more information.
Case Management waiver
The Case Management waiver allows Minnesota to continue to limit case management providers for the home and community-based waivers to counties and tribes under contract with DHS or their subcontractors. The waiver applies only to enrollees whose waiver services are covered under Medicaid fee-for-service and who receive services under one of the following Section 1915(c) home and community-based waiver programs:
- Developmental Disabilities Waiver (DD)
- Elderly Waiver (EW)
- Community Access for Disability Inclusion (CADI) Waiver
- Brain Injury Waiver (BI)
- Community Alternative Care (CAC)
The current Case Management waiver expires March 31, 2027. Review the Case Management Waiver and CMS Approval Letter (PDF) for more information.

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Medicaid waivers
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