CMS approves Washington’s COVID-19 public health emergency 1115 waiver

The Centers for Medicare and Medicaid Services (CMS) approved Washington State’s COVID-19 Public Health Emergency (PHE) section 1115 waiver on Tuesday, marking the first approval of an 1115 waiver specifically intended to combat the impacts of COVID-19.

President Trump’s national emergency declaration on March 13 enabled CMS to waive certain requirements in Medicare, Medicaid, and CHIP under Section 1135 emergency authority. Washington quickly submitted its application and on March 19, CMS approved the state’s 1135 waiver.



Then on March 22, CMS announced it had developed a new section 1115 demonstration opportunity, making available “a number of authorities and flexibilities to assist states in enrolling and serving beneficiaries in Medicaid.”

The Health Care Authority (HCA) submitted its 1115 application to CMS on March 24, stating,

“The State is already exercising various emergency authorities that have been invoked under federal and state law…Ongoing response efforts and a clear-eyed projection of what is ahead have made it clear, however, that the State requires additional federal flexibility and support that is available only through waivers under Section 1115.”

In the application, the state asked for a broad range of new authorities in the way it operates its Medicaid program to better serve beneficiaries during the COVID-19 crisis. Examples include:

  • Establishing a temporary eligibility group for individuals with incomes at or below 200% FPL. The application also proposes using Medicaid funding for additional subsidies for people at or below 200% FPL who are enrolled in qualified health plans. Approximately 60,700 individuals would fall into this temporary eligibility group.
  • Permitting the state to target services on a geographic basis that is less than statewide and to vary the amount, duration, and scope of services based on population needs.
  • Supporting the use of health care providers who are not ordinarily licensed in the state to provide some Medicaid-reimbursable services.
  • The ability to pay higher rates for Home and Community Based Services (HCBS) providers to maintain capacity.
  • Allowing for fast-track eligibility processes during the national public health emergency
  • Allowing long term care services to be approved on a presumptive basis

The state also asked for CMS’s approval to establish a COVID-19 Disaster Relief Fund to support providers during the public health emergency. The fund would support providers as they make investments in telemedicine platforms, off-site screening venues, new sites for quarantine and post-acute care, and the purchase of PPE.

The fund would also support supplemental payments to retain care providers that have seen major utilization declines during the pandemic including behavioral health providers, rural providers, or school-based providers. The application also states that the fund would support childcare for the health care workforce, transportation needs, the costs of testing and treatment for uninsured patients, and the development of a statewide scheduling, testing, and reporting system.

CMS approved several of the state’s requests including:

  • Allowing the state to receive federal reimbursement for providing LTSS to beneficiaries, even if they are not timely, updated in the plan of care, or delivered in otherwise-allowable settings;
  • Allowing for self-attestation or alternative verification of individuals’ eligibility (income/assets) and level of care (LOC) to qualify for LTSS to reduce administrative burden for both the state and beneficiaries;
  • Allowing the state to pay higher rates to certain home and community-based service (HCBS) providers to maintain capacity during the pandemic; and
  • Allowing the state to make retainer payments for many providers of habilitation and personal care services to maintain capacity during the emergency.
  • Allowing the state to make retainer payments to many providers of personal care services and habilitation services that include personal care as a component.

CMS did not, however, approve the state’s request to establish the temporary eligibility group for those with incomes 138-200% FPL, stating that extending payment deadlines and the 3-month grace period has provided consumers with extra times to make payments.

CMS says that they are continuing to review a number of requests in the application, and that the state’s request for Medicaid expenditure authority for a Disaster Relief Fund is still under evaluation.