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How States Apply

Application Template

For new section 1115 demonstrations, states now have the option of using an interim template to develop their own applications.   States may either download and complete the template, or simply use it as guide as they develop the application.  States may submit completed applications to 1115demorequests@cms.hhs.gov.  In 2013, CMS will make available a web-based system that States can use to submit section 1115 demonstration applications electronically.    This system will streamline the state application process and CMS review of pending actions.

Fillable 1115 Demonstration Application

Section 1937 of the Social Security Act as in effect in 2009 – This document provides the statutory language in effect as of December 1, 2009 and may be helpful to section 1115 demonstration states analyzing benefits provided to certain demonstration eligible as of that date.”  

Benchmark Standards in Effect on December 1, 2009

More About the State Application Process

As of April 27th, 2012, States will need to include the following components in the demonstration application in order for CMS to consider it a complete submission.

  • A comprehensive description of the demonstration, including its goals and objectives
  • A description of the proposed health care delivery system, eligibility requirements, benefits and cost-sharing requirements for individuals who will be covered under the demonstration
  • An estimate of the increase or decrease in annual enrollment and expenditures as a result of the demonstration
  • Current enrollment data and projections
  • Other program features that would modify the State’s Medicaid and CHIP programs
  • The specific waiver and expenditure authorities that the State believes to be necessary to authorize the demonstration
  • A research hypothesis and evaluation design related to the demonstration proposal
  • Written documentation of the State’s compliance with the public notice requirements
  • The populations affected by the demonstration
  • The financing of the demonstration
  • Budget neutrality for the demonstration

CMS may also request, or a state may propose, additional information to aid in the review of the application. These requirements apply to new applications; requirements for extensions differ slightly and are described in the final rule at 431.412(c).