Overview
Section 1115 demonstration waivers allow states additional flexibility to design and improve their programs with CMS approval of experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Program (CHIP) programs. Since 1997, the MassHealth 1115 Demonstration has been a critical tool in enabling Massachusetts to achieve and maintain near-universal coverage, sustain the Commonwealth’s safety net, expand critical behavioral health services, and reform the way that care is delivered.
On September 28, 2022, the Centers for Medicare & Medicaid Services (CMS) approved Massachusetts’ request to extend the MassHealth Section 1115 Demonstration Waiver (MassHealth 1115 Demonstration) through December 2027. The 2022-2027 1115 MassHealth Demonstration will continue improving health outcomes and closing health disparities for members, in concert with other MassHealth efforts.
This page is dedicated to the 2022-2027 Demonstration. Previous demonstration periods can be found here: Historic 1115 Demonstration Waiver Documents
2028 – 2032 1115 Demonstration Extension Request
On September 14, 2026, the Massachusetts Executive Office of Health and Human Services (EOHHS) announced its intent to submit a request to extend the MassHealth Section 1115 Demonstration (“Request”) to the Centers for Medicare and Medicaid Services, for the demonstration period from January 1, 2028 – December 31, 2032.
- Demonstration Extension Request: PDF | Word
- Full Public Notice: PDF | Word
- Abbreviated Public Notice: PDF | Word
- Demonstration Extension Request Summary: PDF | Word
- Budget Neutrality: XLS
- 2022-2027 Interim Evaluation Report (IEIR): PDF | Word
EOHHS will host two public hearings to hear public comments on the Request. Stakeholders are invited to review the Request in advance and share with EOHHS staff at the hearings any input and feedback, or questions for future clarification. The public hearings are scheduled as follows:
Public Hearing #1 will be held virtually on:
Thursday, October 1, 2026 from 10:00-12:00
Join Zoom Meeting
Meeting ID: 996 6225 3321
Passcode: 124374
Public Hearing #2 will be held both virtually and in-person on:
Wednesday, October 7, 2026 from 12:00-2:00
One Ashburton Place, Boston MA, 02108, 2nd Floor
Join Zoom Meeting
Meeting ID: 994 0470 9871
Passcode: 213343
Live transcription and closed captioning will be available at both events. Please contact 1115WaiverComments@mass.gov at least one week in advance of each hearing to request reasonable accommodations or additional language translation for either date.
EOHHS will accept written comments on the proposed Request through Monday, October 19, 2026. Written comments may be delivered by email or mail. By email, please send comments to 1115WaiverComments@mass.gov and include “Comments on Demonstration Extension Request” in the subject line. By mail, please send comments to: EOHHS Office of Medicaid, Attn: 1115 Demonstration Comments, One Ashburton Place, 10th Floor, Boston, MA 02108. Comments must be received by 5 pm on October 19, 2026 in order to be considered. Paper or electronic copies of the extension request documents and/or submitted comments may be obtained by emailing a request to 1115WaiverComments@mass.gov or by mailing a request to EOHHS Office of Medicaid, Attn: 1115 Demonstration Comments, One Ashburton Place, 10th Floor, Boston, MA 02108. EOHHS will post comments on the MassHealth 1115 Demonstration website with the final submission to CMS.
Roadmap for MassHealth’s 2028-2032 1115 Demonstration Extension
MassHealth is planning to extend its 1115 Demonstration, which currently ends in 2027. In October 2025, MassHealth released a Roadmap which provided an update on progress from MassHealth's most recent 1115 Demonstrations, and a preview of goals and an anticipated timeline for the next 1115 Demonstration. MassHealth has been releasing updates on subsets of initiatives throughout Winter and Spring 2026.
2028-2032 1115 Demonstration Roadmap, posted October 2025: PDF
2028-2032 1115 Demonstration Extension Update, posted January 2026: PDF
2028-2032 1115 Demonstration Extension Update, posted April 2026: PDF | PPT
2028-2032 1115 Demonstration Extension Update, posted July 2026: PPT
Previous meetings on MassHealth’s 2028-2032 1115 Demonstration Extension Request:
Monday, November 10, 2025 from 12:30-2:00pm
Monday, November 17, 2025 from 2:00-3:30pm
Monday, February 9, 2026 from 12:00-1:30pm
Wednesday, February 25, 2026 from 12:00-1:30pm
Thursday, April 16, 2026 from 11:00 am – 12:30 pm
Wednesday April 29, 2026 from 9:30 – 11:00 am
Thursday, July 9, 2026 from 12:30 - 2:00 pm
For feedback, input, or questions regarding MassHealth’s next 1115 Demonstration Extension Request, or to request technical assistance for public meetings, please reach out to 1115WaiverComments@mass.gov. Please note, MassHealth will hold a formal public comment period on the draft extension request in Fall 2026.
Current MassHealth 1115 Demonstration Documents
- Waiver and Expenditure Authorities, approved 12/13/24: PDF | Word
- Special Terms and Conditions (STCs), approved 8/4/25: PDF | Word
- STC Attachments
- Attachment A. Preparing the Evaluation Design, CMS resource: PDF | Word
- Attachment B. Preparing the Interim and Summative Evaluation Reports, CMS resource: PDF | Word
- Attachment C. Cost-Sharing, approved 5/30/24: PDF | Word
- Attachment D. SUD Health IT Plan, approved 3/1/23: PDF | Word
- Attachment E. Safety Net Care Pool Payments
- Attachment F. SMI/SED Implementation Plan, approved 3/1/23: PDF | Word
- Attachment G. SUD and SMI/SED Monitoring Protocol, approved 11/3/23 - Part A: XLS Part B: PDF | Word
- Attachment J. Hospital Quality and Equity Initiative (HQEI) Implementation Plan Performance Years, 1-5 approved 1/15/25: PDF | Word
- Attachment K. Monitoring Protocol for Other Policies (Reserved)
- Attachment L. Pricing Methodology for Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs), approved 6/21/23: PDF | Word
- Attachment M. DSRIP Protocol, approved 6/21/23: PDF | Word
- Attachment N. Safety Net Hospital Provider Payment Eligibility and Allocation Protocol, approved 1/15/25: PDF | Word
- Attachment P. Health Related Social Needs (HRSN) Protocol, approved 12/13/24: PDF | Word
- Attachment Q. Medicaid Managed Care Entity/ACO Performance-Based Payment, Mechanisms , approved 5/19/23: PDF | Word
- Attachment R. DSRIP Flexible Services Protocol, approved 9/2/21: PDF | Word
- Attachment S. Evaluation Design Document, approved 3/10/26:PDF | Word
- Attachment T. Health Related Social Needs (HRSN) Implementation Plan, approved 1/15/25: PDF | Word
- Attachment U. Primary Care Payment Protocol, approved 12/13/24
- Attachment V: Medicare vs. Medicaid Provider Rate Attestation Table, approved 11/22/23: PDF | Word
- Attachment W. Reentry Services, approved 4/30/24: PDF | Word
- Attachment X. Reentry Implementation Plan, approved 5/29/25: PDF | Word
- Attachment Y. Reentry Reinvestment Plan (Reserved)
- Attachment Z. DSHP List, approved 6/25/24: PDF | Word
- Attachment AA. DSHP Claiming Protocol, approved 7/31/24: PDF
- Attachment BB. DSHP Sustainability Plan (Reserved)
- Attachment AC. Waiver Authorities for the Consolidated Appropriations Act, 2023, approved 12/9/24: PDF | Word
2026
Submission of MassHealth Transition and Phase-Out Plan for Certain 1115 Populations
Submitted August 27, 2026
MassHealth Transition and Phase-Out Plan for Certain 1115 Populations as Posted for Public Comment
Posted for Public Comment June 5, 2026 – July 6, 2026
On June 5, 2026, in order to comply with new federal law, MassHealth announced its intent to submit a Transition and Phase-Out Plan to CMS to terminate 1115 Demonstration Expenditure Authority permitting MassHealth to enroll individuals receiving Transitional Assistance for Needy Families (TANF) and Emergency Aid to Elderly Disabled and Children (EAEDC) through the Massachusetts Department of Transitional Assistance (DTA). The Transition and Phase Out-Plan outlines the specific request and plans to notify members.
2025
Approval of MassHealth 1115 Demonstration Technical Corrections
Approved August 4, 2025
- 1115 Demonstration Technical Corrections Approval Letter: PDF
- STCs: PDF | Word
- Attachment AC. Waiver Authorities for the Consolidated Appropriations Act, 2023, approved 12/9/24, renamed from on 8/4/25 (previously known as Attachment CC): PDF | Word
MassHealth 1115 Demonstration Amendment Request as Posted for Public Comment
Posted for Public Comment January 21, 2025 – February 20, 2025
- Demonstration Amendment Request: PDF | Word
- Public Notice: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: PDF | XLS
Other 2025 Demonstration Activity
Public Meeting: MassHealth 1115 Demonstration Waiver and Delivery System Restructuring Progress
MassHealth held a public meeting on March 28, 2025 from 10 -12 a.m. to present the annual report on the progress of delivery system restructuring efforts and the Delivery System Reform Incentive Program (DSRIP) for calendar year 2022, as well as to provide an opportunity for the public to comment on the progress of the current 1115 MassHealth Demonstration. Stakeholders will have an opportunity to ask questions and provide feedback. Please see 1115 Demonstration ("Waiver") Reports | Mass.gov for the most recent Demonstration Year 28 (DY28) Annual Report on the 1115 Demonstration.
2024
Approval of MassHealth 1115 Demonstration Technical Corrections
Approved December 13, 2024
- 1115 Demonstration Technical Corrections Approval Letter: PDF
- Waiver and Expenditure Authorities: PDF | Word
- STCs: PDF | Word
Approval of MassHealth 1115 Demonstration Amendment
Approved December 9, 2024
- 1115 Demonstration Amendment Approval Letter:PDF | Word
- Attachment CC: Waiver Authorities for Consolidated Appropriations Act, 2023: PDF | Word
MassHealth 1115 Demonstration Amendment Request as Posted for Public Comment
Posted for Public Comment October 11, 2024 – November 12, 2024
- Demonstration Amendment Request: PDF | Word
- Public Notice: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: PDF | Excel
- MassHealth 1115 Demonstration Amendment Request as Posted for Public Comment: PDF | Word
Approval of MassHealth 1115 Demonstration Amendment Request
Submitted May 3, 2024. Approved June 25, 2024
- 1115 Demonstration Amendment Approval Letter: PDF
- Waiver and Expenditure Authorities: PDF| Word
- STCs: PDF | Word
- Budget Neutrality Workbook: XLS
Submission of MassHealth 1115 Demonstration Amendment Request
Submitted May 3, 2024
- 1115 Demonstration Amendment Request submitted to CMS: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: XLS | Word
Approval of MassHealth 1115 Demonstration Amendment Request
Submitted October 16, 2023, Approved April 19, 2024
- 1115 Demonstration Amendment Approval Letter: PDF | Word
- Waiver and Expenditure Authorities: PDF | Word
- STCs : PDF | Word
- Budget Neutrality Workbook: XLS
MassHealth 1115 Demonstration Amendment Request As Posted for Public Comment
Posted for Public Comment March 27, 2024 – April 26, 2024
- 1115 Demonstration Amendment Request: PDF | Word
- Public Notice: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: PDF | XLS
- Public Comments to Proposed MassHealth 1115 Waiver Amendment Request: PDF | Word
Other 2024 Demonstration Activity
Approval of Certified Public Expenditure (CPE) Methodology
On September 30, 2024 CMS approved MassHealth’s CPE Methodology for the MassHealth Temporary Housing Assistance for Families and Pregnant Individuals Program: PDF | Word
Public Meeting on MassHealth 1115 Demonstration and Delivery System Restructuring Progress
On March 1, 2024, MassHealth held a public meeting to present the annual report on the progress of delivery system restructuring efforts and the Delivery System Reform Incentive Program (DSRIP) for calendar year 2021, as well as to provide an opportunity for the public to comment on the progress of the current 1115 MassHealth Demonstration. Stakeholders will have an opportunity to ask questions and provide feedback. Please see 1115 Demonstration ("Waiver") Reports | Mass.gov for the most recent Annual Report on the 1115 Demonstration.
Reasonable Accommodation: If you require an ADA accommodation, please contact 1115 WaiverComments@mass.gov.
Community Feedback Forum for Health and Justice
On January 29, 2024, MassHealth posted a Notice of Opportunity (NOO) to solicit stakeholders to participate in MassHealth's Community Feedback Forum for Health & Justice. This Forum will advise EOHHS on key policy decisions related to the request for and implementation of its 1115 Demonstration initiative to cover certain MassHealth services for eligible individuals who are incarcerated in a Massachusetts Department of Corrections, County Correctional, or Department of Youth Services facility in the 90-day period before the individuals are released from incarceration.
MassHealth has again updated its Notice of Opportunity (NOO) to participate in MassHealth's Community Feedback Forum for Health & Justice. The update to the NOO extends the deadline for applications until April 30, 2024, at 4 p.m.
More details can be found in the attached documents, or on COMMBUYS at COMMBUYS Bid Solicitation or by searching the keywords “Community Feedback Forum.”
2023
Submission of MassHealth 1115 Demonstration Amendment Request
Submitted October 16, 2023
- 1115 Demonstration Amendment Request Submitted to CMS: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook Submitted to CMS: PDF | Excel
- Public Comments to Proposed MassHealth Section 1115 Demonstration Amendment Request: PDF | Word
MassHealth 1115 Demonstration Amendment Request as Posted for Public Comment
Posted for Public Comment August 2,2023 – September 9, 2023
- 1115 Demonstration Amendment Request: PDF | Word
- Public Notice: PDF | Word
- Fact Sheet: PDF | Word
- Budget Neutrality Workbook: PDF | Excel
Approval of Technical Corrections for Demonstration Extension
Approved June 21, 2023
2022
Approval of MassHealth 1115 Demonstration Extension
Approved September 28, 2022
- 1115 Demonstration Approval Letter: PDF | Word
- 1115 Demonstration Approval Fact Sheet: PDF | Word
- 1115 Demonstration Extension Summary: PDF | Word
For more information about the request to extend the 1115 Demonstration, please see: 1115 MassHealth Demonstration ("Waiver") Extension Request
| Last updated: | September 14, 2026 |
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