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

This page aggregates tracking information on approved Medicaid emergency authorities to address the COVID-19 Coronavirus emergency. We currently include details on Section 1135 waivers, Medicaid Disaster Relief State Plan Amendments (SPAs), and 1915 (c) Waiver Appendix K strategies. States may also take actions to respond to COVID-19 through regular SPA and other administrative authorities. We are collecting information on those actions, which will be added to this tracking page soon. Please check back for updates.

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

 

Section 1135 waivers: 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 are 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

 

Medicaid Disaster Relief State Plan Amendments: CMS has 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. In addition to these substantive state plan changes, states can request Section 1135 waiver authority to permit changes to become effective as early as January 1, 2020, even if the SPA is submitted after March 30, 2020; eliminate public notice requirements associated with certain SPA changes; and modify the timeframe for tribal consultation on SPA changes. Approved state Medicaid Disaster Relief SPAs are summarized in the table below, while any Section 1135 provisions related to SPA flexibility are in the table above.

 

Approved Medicaid Disaster Relief SPAs to Address COVID-19

 

Section 1915 (c) Waiver Appendix K Strategies: 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). 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 a sample Appendix K template for COVID-19 for COVID-19 waiver amendment requests.

 

Approved Section 1915 (c) Waiver Appendix K Strategies to Address COVID-19