During these unprecedented times, the Centers for Medicare & Medicaid Services (CMS) constantly updates its guidance regarding Section 1115 demonstration and other waiver and State Plan authorities. Our summary reflects the most current CMS 1115 waiver guidance and state submissions as of April 9, 2020.
The Section 1115 demonstration opportunity under Title XIX (Medicaid) of the Social Security Act (Act) has been issued by CMS to assist states with addressing the COVID-19 public health emergency:1
Declared by Health and Human Services on Jan. 31, 2020.
Presidential Declaration under 501(b) of the Robert T. Stafford Act on March 13, 2020.
Allows states to select from a variety of options to deliver care to Medicaid beneficiaries.
Available for a limited time and will expire no later than 60 days after the end of the public health emergency.
Demonstration authority is retroactive to March 1, 2020.2
1 Lynch, C, “SMDL #20-002 RE: COVID-19 Public Health Emergency Section 1115(a) Opportunity for States” to State Medicaid Directors, 3/22/20. CMS Center for Medicaid & CHIP Services. Available online https://www.medicaid.gov/sites/default/files/Federal-Policy-Guidance/Downloads/smd20002-1115template.docx 2 The March 1, 2020, retroactive date indicated in SMDL #20-002 differs from a Jan. 27, 2020, retroactive date provided in the CMS COVID-19 Frequently Asked Questions document, updated on April 2, 2020. Available online https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf. We are awaiting official CMS clarification.
Yelena Barzilla, LL.B., LL.M., CHC