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Section 1115 Demonstration Waiver for Substance Use Disorder (SUD) Treatment

Overview

Questions and comments about the Demonstration may be sent to ct-sud-demo@ct.gov.

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Substance Use Disorder (SUD) Section 1115 Demonstration Waiver Extension Request Pursuant to Section 1115 of the Social Security Act

Pursuant to section 17b-8 of the Connecticut General Statutes and 42 C.F.R. § 431.408, the Department of Social Services (DSS) provides notice that it intends to submit to the Centers for Medicare & Medicaid Services (CMS) a Substance Use Disorder (SUD) Demonstration Waiver Extension pursuant to Section 1115 of the Social Security Act for Connecticut’s Medicaid Program and Children’s Health Insurance Program (CHIP) (Demonstration). Connecticut is seeking federal approval to extend its Medicaid SUD Demonstration Waiver, effective on April 1, 2027, to March 31, 2032. The Extension requests no changes to the SUD portion of the demonstration, except for a minor technical correction to the HUSKY A Medicaid eligibility group, for budget neutrality, to account for increased costs associated with non-SUD services. All pending amendments, including the amendment to implement a “Re- entry Initiative” to better support individuals’ reentry from incarceration to the community (including addressing social determinants of health (SDoH) for individuals reentering the community), are proposed to be incorporated into the amendment (or extended authorization if the amendment is approved prior to the renewal).

The Department of Social Services (DSS), in collaboration with the Department of Children and Families (DCF) and the Department of Mental Health and Addiction Services (DMHAS), proposes a SUD demonstration waiver extension pursuant to section 1115 of the Social Security Act (Demonstration).  For public review and comment, please see the following documents:

Where and When to Submit Written Comments

To send comments about the Demonstration Extension, please email: Public.Comment.DSS@ct.gov or write to: Department of Social Services, Medical Policy Unit, 55 Farmington Avenue, 9th Floor, Hartford, CT 06105. In any correspondence, please reference “SUD 1115 Demonstration Waiver Extension.” Please also send any other questions about the Demonstration to this contact information, including requests for a copy of the Demonstration (and/or related materials).

Anyone may send DSS written comments about the Demonstration Extension. Written comments must be received by DSS at the above contact information no later than January 18, 2026 (which is more than 30 days after the date of the publication of this notice in the Connecticut Law Journal. Please note that comments received will also be posted to the same website referenced above.

Public Hearings

In addition to the opportunity for anyone to send DSS written comments noted above, there will also be one in-person hearing (with an optional virtual platform for people to attend remotely) and one electronically convened public hearing to afford anyone the opportunity to provide DSS with verbal comments. Members of the public will be invited to make comments in-person, via the telephone or the virtual platform, Zoom, as follows:

Public Hearing with optional virtual Webinar Hosted by DSS

December 22, 2025

Time: 10:00 A.M. – 12:00 P.M.

In-person at: 55 Farmington Avenue, First Floor, Room 1011, Hartford, CT 06105.

Web Conference/Teleconference:

Topic: Substance Use Disorder Demonstration Waiver Extension Public Hearing
Join Zoom Meeting
https://us06web.zoom.us/j/86785379034?pwd=WKIMSuKbiUuDK2Dun4TXSnBB0B3r2z.1

Meeting ID: 867 8537 9034
Passcode: 988428
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Join instructions
https://us06web.zoom.us/meetings/86785379034/invitations?signature=9yOtksi4kL1dnL-QybU-89TMqQE1JfziiQglIWNSIM8

Public Hearing Convened by the Connecticut General Assembly Medical Assistance Program Oversight Council

January 9, 2026

Time: 1:00 P.M. – 3:30 P.M.

Join Zoom Meeting

https://zoom.us/j/97350054937?pwd=JCoO97AjaR2cbVSgXNEZjAx5IV2nt2.1

Meeting ID: 973 5005 4937
Passcode: 919295

One tap mobile:
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Join instructions
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Section 1115 Demonstration Waiver for Substance Use Disorder Treatment

As part of the U.S. Department of Health and Human Services’ effort to combat the ongoing opioid crisis, the Centers for Medicare & Medicaid Services (CMS) created an opportunity under the authority of section 1115(a) of the Social Security Act for states to demonstrate and test flexibilities to improve the continuum of care for beneficiaries with substance use disorders (SUD) including Opioid Use Disorder (OUD).

The Connecticut Department of Social Services (DSS) requested an 1115 Demonstration Waiver for SUD inpatient and residential treatment for adults and children under fee‑for‑service (FFS). Connecticut also requested this Demonstration to ensure a complete American Society of Addiction Medicine (ASAM) levels of care (LOCs) service array is available as part of an essential continuum of care for Medicaid‑enrolled individuals with OUD and other SUDs. Connecticut requested the Demonstration amendment be effective immediately upon approval to use Institutions for Mental Diseases (IMDs) as a Medicaid‑covered setting.

Connecticut Medicaid covers all ambulatory ASAM Level of Care (LOCs) 0.5 through 2.5, as well as inpatient withdrawal management (ASAM level 4-WM). Connecticut will be submitted a Medicaid State Plan Amendment (SPA) in conjunction with this Demonstration to cover residential and inpatient treatment, as well as all levels of withdrawal management (ASAM levels 1-WM, 2-WM, 3.1, 3.2-WM, 3.3, 3.5, 3.7, 3.7-WM, 4). The Demonstration will permit DSS to provide critical access to medically necessary SUD treatment services in the most appropriate setting for the member as part of a comprehensive continuum of SUD treatment services.

Additional information about SUD 1115 demonstrations, including a list of all states that have already established a SUD 1115 demonstration, can be found on the CMS website at this link: https://www.medicaid.gov/medicaid/section-1115-demonstrations/1115-substance-use-disorder-demonstrations/section-1115-demonstrations-substance-use-disorders-serious-mental-illness-and-serious-emotional-disturbance/index.html.  Connecticut’s SUD 1115 application, approval letter and Special Terms and Conditions of the waiver as well as all required reporting and evaluation deliverables are accessible at this webpage: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html (select the appropriate filters within the webpage to find the relevant waiver application).

On June 25, 2025, the Centers for Medicare & Medicaid Services (CMS) updated the section 1115 demonstration monitoring approach to reduce state burden, promote effective and efficient information sharing, and enhance CMS’s oversight of program integrity by reducing variation in information reported to CMS. Federal section 1115 demonstration monitoring and evaluation requirements are set forth in section 1115(d)(2)(D)-(E) of the Social Security Act (the Act), in CMS regulations in 42 CFR 431.428 and 431.420, and in Connecticut’s 1115 waiver demonstration special terms and conditions (STCs). Monitoring provides insight into progress with initial and ongoing demonstration implementation and performance, which can detect risks and vulnerabilities to inform possible course corrections and identify best practices.

Key changes of the monitoring redesign initiative include introducing a structured template for monitoring reporting, updating the frequency and timing of submission of monitoring reports, and standardizing the cadence and content of the demonstration monitoring calls. The CMS Overlay letter below details the changes to the SUD 1115 waiver demonstration with attached Special Terms and Conditions (STCs).

Connecticut Substance Use Disorder Demonstration Overlay Letter

Submission to the Centers for Medicare & Medicaid Services (CMS) - Substance Use Disorder (SUD) Section 1115 Demonstration Waiver

On August 9, 2021, the Department of Social Services (DSS) formally submitted to CMS the following documents for review:

The State’s SUD 1115 Waiver application, implementation plan and SUD Health Information Technology (HIT) plan were approved by CMS on April 14, 2022 and is effective from the approval date through March 31, 2027.  The approval document contains the CMS approval letter as well as the special terms and conditions (STCs) for the demonstration. The State’s Acceptance of Award and STCs was sent to CMS on April 28, 2022.

Responses to Public Comments – Substance Use Disorder (SUD) Section 1115 Demonstration Waiver

After completion of the public comment period and public hearings described below, DSS issued formal responses to comments and revised the draft waiver application.  These documents are posted here:

Public Comment & Public Hearings – Substance Use Disorder (SUD) Section 1115 Demonstration Waiver

The Department of Social Services (DSS), in collaboration with the Department of Children and Families (DCF) and the Department of Mental Health and Addiction Services (DMHAS), proposes a SUD demonstration waiver under section 1115 of the Social Security Act (Demonstration), described below.  For public review and comment, please see the following documents:

Public Comments: Written comments are accepted from February 2, 2021 through March 4, 2021. Please send comments to: Public.Comment.DSS@ct.gov

Public Hearings: There will be two electronic public hearings (accessible by electronic device and telephone).  Links and call-in information are contained within the public notice.  Please check this webpage regularly for updates before logging onto the public hearing.

 

 

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