Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19

During the COVID-19 Public Health Emergency, states used a number of Medicaid emergency authorities to address the coronavirus emergency. Between March 2020 and July 2021 we tracked 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. This page aggregates tracking information on approved Medicaid emergency authorities. This page was last updated July 1, 2021 and is no longer being updated.

Contents of Tracker:

Visit our State Data and Policy Actions COVID-19 Tracker for additional data on state responses to COVID-19, and our special coronavirus topic page for all our resources.

Approved Medicaid Emergency Authorities as of July 1, 2021

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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, 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 provided a template for 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 and/or are pending 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.



SPA and Other Administrative Actions to Address COVID-19 as of July 1, 2021

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Section 1115 Waivers to Address COVID-19: In response to the COVID-19 public health emergency, CMS developed a new Medicaid 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 long-term services and supports (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. States must complete a final monitoring and evaluation report one year after the demonstration ends. These demonstrations could be retroactive to March 1, 2020 and will expire no later than 60 days after the end of the public health emergency.



Approved Section 1115 Waivers to Address COVID-19 as of July 1, 2021

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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 Section 1135 authority to 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) issued blanket Section 1135 waivers for many Medicare provisions. Additionally, states were able to submit to CMS for approval Section 1135 waivers for Medicaid provisions. These approved state waivers are summarized in the table below.



Approved Section 1135 Waivers to Address COVID-19 as of July 1, 2021

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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 posted a sample Appendix K template for COVID-19 for COVID-19 waiver amendment requests. Per updated guidance in December 2020, CMS may extend emergency authorities adopted under Appendix K through up to six months after the public health emergency ends.



Approved Section 1915 (c) Waiver Appendix K Strategies to Address COVID-19 as of July 1, 2021

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