1115 Substance Use Disorder demonstration waiver project

*For ASAM Certification visit ASAM resources for Minnesota SUD treatment providers.

The 1115 substance use disorder (SUD) demonstration waiver project expands access to high quality, clinically appropriate SUD treatment using American Society for Addiction Medicine (ASAM) levels of care. 

The waiver authorizes federal Medicaid matching funds for residential programs that have been determined as Institutions for Mental Diseases. It 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. 

DHS submitted an extension request to CMS on Dec. 21, 2023, to continue the waiver. On Nov. 25, 2025, the Centers for Medicare and Medicaid Services (CMS) provided a fifth temporary extension that continues the operational terms of the waiver through March 31, 2026. The temporary extension of the waiver does not impact providers or people receiving services. DHS anticipates that CMS will complete its review of the waiver extension request during this temporary extension period.

For questions or comments please email: 1115demonstration.dhs@state.mn.us.

Waiver Background

Section 1115 of the Social Security Act allows the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to approve demonstration projects that are likely to improve state Medicaid programs (called Medical Assistance [MA] in Minnesota). 

Improvements were made through implementing the American Society for Addiction Medicine (ASAM) Criteria, the ASAM full continuum of care and increasing access to medication for opioid use disorder (MOUD). States receive federal financial participation (FFP) for services provided in Institutions for Mental Diseases (IMDs), defined as residential facilities with more than 16 beds. Federal laws typically exclude IMDs from Medicaid reimbursement.  

On July 22, 2020, CMS approved the Minnesota’s implementation plan and Special Terms & Conditions (STCs), marking the official start of Minnesota’s 1115 SUD Demonstration. The STCs are the state’s contract with CMS during the demonstration. Minnesota has achieved its demonstration implementation plan objectives and continues to make progress within the six ongoing demonstration goals:

  1. Increased rates of identification, initiation and engagement in treatment for SUD 
  2. Increased adherence to and retention in treatment
  3. Fewer readmissions to the same or higher levels of care where the readmission is preventable or medically inappropriate
  4. Improved access to care for physical health conditions among Medicaid beneficiaries
  5. Reduce the number of opioid related overdoses and deaths within the state of Minnesota 
  6. Allow for patients to receive a wider array of evidence-based services that are focused on a holistic approach to treatment