CMS approves Washington’s Medicaid Transformation Project waiver extension request for five more years


Shane Ersland


The Centers for Medicare & Medicaid Services (CMS) recently approved Washington’s request to extend and amend its Section 1115 Medicaid Transformation Project waiver


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The extension will allow Washington to implement new policies and use federal Medicaid funds to improve Apple Health, the state’s Medicaid program. The waiver ended on June 30th, and the extension runs through June 30th, 2028.

Washington Medicaid Director Charissa Fotinos, MD, said the extension will allow the state to test the effectiveness of innovative practices aimed at promoting consistently high-quality, evidence-based, coordinated, and integrated care in a statement following CMS’ approval of the state’s request.

“With this extension, Washington is also introducing new initiatives and investments to assist the state in improving health coverage, access, and consistent provision of high-quality services for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, all while advancing health equity among its beneficiary populations. 

Overall, the goal of the demonstration is to provide medical assistance and improve the health of communities and populations. This extension will lead to additional populations being served by Medicaid, as well as additional services being furnished to Medicaid and CHIP beneficiaries.”


The extension permits the state to continue its Medicaid Alternative Care and Tailored Supports for Older Adults programs by adding covered services and increasing TSAO eligibility standards. The programs expand care options for older residents so they can stay in their homes, and delay or avoid more intensive situations, such as the need to move into a nursing facility. It also assists unpaid family caregivers. 

CMS also approved the state’s request for contingency management, an evidence-based tool used in treating substance abuse disorder (SUD). It includes a series of incentives for meeting treatment goals, and has been effective in increasing rates of drug abstinence for a range of SUDs, including stimulants, cannabis, alcohol, and tobacco.

The extension also allows the state to provide full Medicaid benefits to postpartum individuals with incomes up to 193 percent of the federal poverty level who apply for Medicaid or CHIP during their postpartum period, but who were not previously enrolled in Medicaid or CHIP during their pregnancy, until 12 months after their pregnancy ends.

Additional newly approved programs include:

  • Re-entry coverage for individuals leaving a prison, jail, or youth correctional facility
  • Program innovations that support older adults, including expanded eligibility and presumptive eligibility to support access and enrollment
  • Continuous Apple Health enrollment for children through age five
  • Programs that address health-related social needs (HRSN), including community-based payment through community/Native hubs, rental subsidies for up to six months, and HRSN services for nutrition, housing, medical respite, and transportation

CMS denied Washington’s request to cover postpartum care for non-citizens. The state therefore cannot use waiver funds to support the initiative, but plans to use other funding resources to provide postpartum care for non-citizens.