CMS Approves First Emergency Medicaid Waiver Request to Accelerate Access to Services in Response to COVID-19

Alerts / March 17, 2020

Under Section 1135 of the Social Security Act, the Secretary of the U.S. Department of Health and Human Services (HHS) is authorized to temporarily waive or modify certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements to ensure sufficient healthcare items and services are available to meet the needs of individuals enrolled in Social Security Act programs. Following President Trump’s declaration of a national emergency, Florida became the first state to submit a request for a Section 1135 Medicaid waiver in response to COVID-19.

Florida’s approval letter contained flexibilities that enable the state to waive prior authorization requirements, streamline provider enrollment processes to ensure access to care for beneficiaries, allow care to be provided in alternative settings in the event a facility is evacuated to an unlicensed facility, suspend certain nursing home screening requirements, and extend deadlines for appeals and state fair hearing requests. The waiver has a retroactive effective date of March 1, 2020. Florida’s approval letter can be found here.

The Centers for Medicare & Medicaid Services (CMS) expects more states to submit similar requests. CMS Administrator Seema Verma stated, “CMS is committed to removing all unnecessary administrative and bureaucratic barriers that may hinder an effective response to this public health emergency, and I have directed my team to expeditiously process these requests.” Additional Section 1135 approval letters will be posted here.

Section 1135 waivers typically end no later than the termination of the emergency period, or 60 days from the date the waiver is first published, unless the HHS Secretary extends the waiver by notice for additional periods of up to 60 days, up to the end of the emergency period.

Authorship Credit: Charlene McGinty, Amy Fouts and Maureen Furino

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