CMS Grants Program Flexibility to 11 More States for Medicaid and CHIP


On March 23, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that the agency has approved 11 additional waivers requested by states in response to the SARS-CoV-2 outbreak pursuant to Sec. 1135 of the Social Security Act. The authority to approve these requests is automatically granted to CMS whenever both the President of the United States declares a national emergency and the Secretary of the Department of Health and Human Services (HHS) declares a public health emergency. HHS Sec. Azar declared a public health emergency on January 31, 2020 and President Trump subsequently declared a national emergency on March 13, 2020 in response to the outbreak of Coronavirus Disease 2019 (COVID-19), which is the disease caused by SARS-CoV-2, otherwise known as “coronavirus.” Under Sec. 1135 of the Social Security Act, states can request to waive requirements of public health programs that they administer to ensure that they are able to deliver the health care treatments and services that program enrollees need during emergencies. During that same time, the Secretary of HHS can waive similar requirements for the Medicare program. Waivers will remain effective until the public health emergency concludes and have a retroactive effective date of March 1, 2020.

As of March 25, 2020, 13 states have received approval from CMS for their Sec. 1135 waivers, including Alabama, Arizona, California, Florida, Illinois, Louisiana, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina, Virginia, and Washington. These waivers provide several forms of relief during the COVID-19 outbreak, including waiving prior authorization and provider enrollment requirements, suspending nursing home and pre-admission reviews, and providing reimbursement for health care practitioners delivering care in alternative settings due to evacuations. These waivers will help public health programs operate efficiently during the COVID-19 outbreak and will reduce barriers to care for program enrollees who have been exposed to the virus. On March 22, 2020, CMS published a template request to assist states in their submission of Sec. 1135 requests. The template includes a list of program requirements that states can request to waive and includes the option for states to request to waive additional program requirements beyond those already listed.

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