SCI has just published an issue brief that examines new directions in recent section 1115 demonstration approvals and proposals. Previous SCI publications on the federal Health Insurance Flexibility and Accountability (HIFA) initiative, “HIFA at Age Two: Opportunities and Limitations for States“ (November 2003) and “Health Insurance Flexibility and Accountability Initiative: Opportunities and Issues for States” (August 2002), reviewed both early and subsequent demonstration approvals. This new brief takes a closer look at the more recent wave of 1115 demonstrations. The authors discuss trends in new financing arrangements, the development of defined contribution and individual accounts, and new benefit designs. This publication also discusses the many environmental factors which may influence the success of the new demonstrations, as well as the shape of future ones.