This page aggregates tracking information on approved Medicaid emergency authorities to address the COVID-19 Coronavirus emergency. We include details on Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 Waivers; Section 1135 Waivers; and 1915 (c) Waiver Appendix K strategies.
Contents of Tracker:
Map: Approved Medicaid Emergency Authorities
Emergency Authority Detailed Tables:
SPA and Other Administrative Actions to Address COVID-19
Approved Section 1115 Waivers to Address COVID-19
Approved Section 1135 Waivers to Address COVID-19
Approved Section 1915 (c) Waiver Appendix K Strategies to Address COVID-19
Medicaid and CHIP State Plan Amendments and Other State-Reported Administrative Actions to Address COVID-19:This table summarizes changes approved through Medicaid Disaster Relief SPAs and other Medicaid and CHIP SPAs based on approvals posted to Medicaid.gov, and also includes information on state-reported administrative actions to respond to COVID-19 based on review of state Medicaid agency and other state-level websites. CMS has provided atemplatefor states to request approval of Medicaid Disaster Relief State Plan Amendments (SPAs) related to the COVID-19 National Emergency. The Disaster Relief SPA allows states to make temporary changes to their Medicaid state plans and address access and coverage issues during the COVID-19 emergency. States can also make changes through traditional SPAs and can implement changes under existing authority that do not require SPA approval. (Note that some state-reported actions may require SPA approval.) Data under the “Telehealth” header are provided by Manatt Health (for more information see notes below the table). While this table captures state-reported actions taken in response to the COVID-19 emergency, there is considerable variation across states and states may have adopted policy options prior to the emergency that are not reflected here. Any information on state actions that are not identified here can be sharedhere(please select Medicaid as the topic for comment).
Section 1115 Waivers to Address COVID-19:In response to the COVID-19 public health emergency, CMS developed a newMedicaid Section 1115 demonstration opportunity and application template. These demonstrations can be used to extend HCBS flexibilities available under 1915 (c) home and community-based services waiver Appendix K (separately detailed in this tracker) to beneficiaries receiving LTSS under SPA authorities (such as 1915 (i) state plan HCBS and 1915 (k) Community First Choice) and to allow for applicant self-attestation of resources for the purpose of determining eligibility for certain groups. CMS may also consider approving other provisions under this demonstration opportunity. State and federal public comment periods and budget neutrality requirements will not apply; however, states must complete a final monitoring and evaluation report one year after the demonstration ends. These demonstrations can be retroactive to March 1, 2020 and will expire no later than 60 days after the end of the public health emergency.
Section 1135 Waivers to Address COVID-19:If the President has declared an emergency or disaster and the Secretary of Health and Human Services (HHS) has declared a public health emergency, the Secretary can use Section1135 authorityto waive or modify certain Medicare, Medicaid, and CHIP requirements to ensure that sufficient health care items and services are available to meet the needs of Medicaid enrollees in affected areas. On March 13, 2020, President Trump issued a proclamation that the COVID-19 outbreak in the United States constitutes a national emergency, beginning March 1, 2020. After this declaration, the Center for Medicare and Medicaid Services (CMS) issuedblanket Section 1135 waiversfor many Medicare provisions. Additionally, states are able to submit to CMS for approval Section 1135 waivers for Medicaid provisions. These approved state waivers are summarized in the table below.
Section 1915 (c) Waiver Appendix K Strategies to Address COVID-19:Most Medicaid home and community-based services (HCBS) are provided through Section 1915 (c) waivers. Other states use Section 1115 to authorize HCBS that could have been provided under Section 1915 (c). The table below includes Appendix K approvals for both 1915 (c) and 1115 HCBS waivers. States can use Section 1915 (c) waiver Appendix K to amend either of these HCBS waivers to respond to an emergency. For example, states can modify or expand HCBS eligibility or services, modify or suspend service planning and delivery requirements, and adopt policies to support providers. CMS has posted asample Appendix K template for COVID-19for COVID-19 waiver amendment requests.