States operate it programs, according to federal guidelines, and are free to choose how best to provide care, what populations and services to cover, and how much to compensate providers.

If the Secretary of HHS finds that Section 1115 exemptions will further program goals, states may be able to request them to test and implement strategies that deviate from federal legislation requirements.

The pandemic also brought long-standing concerns to the attention of policymakers, such as programs aimed at addressing workforce issues, reducing health inequities, increasing access to treatment via telemedicine, and enhancing access to behavioral health and home and community-based services.