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Medicaid, CHIP Resources for COVID-19 Response

The Centers for Medicare & Medicaid Services (CMS) March 22 issued several new tools to support state Medicaid and Children’s Health Insurance Program (CHIP) agencies as they respond to the COVID-19 outbreak.

The checklists and templates allow states to apply for regulatory relief and flexibility to address the needs of state Medicaid and CHIP programs during the emergency. 

Section 1115 Waivers

CMS issued a State Medicaid Director Letter detailing a new Section 1115 demonstration waiver targeted at the COVID-19 outbreak. Under this new waiver opportunity, states have the option to select from several authorities and the flexibility to facilitate care to Medicaid and CHIP beneficiaries during the outbreak. This includes extending home- and community-based services and streamlining eligibility determinations for some vulnerable populations.

COVID-19 Section 1115 waivers are time-limited, expiring no later than 60 days after the public health emergency ends. These waivers also will not be subject to budget neutrality requirements, but states are required to track expenditures. Last, participating states will have to submit a report to CMS one year after the end of the waiver. The purpose of the report is to capture information about implementation, lessons learned, and best practices.

The letter includes a template for states to request the demonstration waiver, which the agency will review on a state-by-state basis. CMS will exercise its discretionary authority to expedite the approval process for requested waivers under this opportunity, including by not requiring states to conduct the normal public notice process.

Section 1135 Waivers

CMS released a checklist to aid states seeking Medicaid-targeted Section 1135 waivers. The checklist includes commonly requested 1135 authorities and is intended to expedite the application and approval of state requests. The authorities included in the checklist include waiving prior authorization requirements, easing provider enrollment requirements, allowing out-of-state providers to bill for services, and extending fair hearing and appeals timelines.

CMS earlier this month approved Section 1135 waiver requests from Washington and Florida, and issued several blanket waivers.

1915(c) Waivers

CMS developed an Appendix K template to amend 1915(c) home- and community-based services waivers. States can use this appendix to modify one or all approved 1915(c) waivers during an emergency. The appendix also allows states to use other flexibility under the waiver authority, such as leveraging the ability to provide some services through an electronic method or adding services for beneficiaries covered under the waiver during the emergency.

State Plan Amendments

CMS issued a Medicaid Disaster State Plan Amendment (SPA) template that allows states to submit combined requests to temporarily make changes to their programs. The agency also issued an accompanying document providing detailed instructions on applying for this SPA.

States can use the Medicaid Disaster SPA request to expand Medicaid eligibility to optional populations,extend hospital presumptive eligibility, increase provider reimbursements, and make other changes related to the COVID-19 outbreak.

CMS intends to post all approved waiver and SPA requests on their website.

America’s Essential Hospitals has created a coronavirus resource page that provides up-to-date information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Zina Gontscharow is a former senior policy analyst for America's Essential Hospitals.

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