CMS Releases Four Medicaid Waiver Templates To Fight Coronavirus

March 23, 2020 - On March 22, the Trump Administration released materials to guide Medicaid and CHIP programs to effectively orient and pursue coronavirus relief efforts.

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“CMS is making it easier and faster for state Medicaid agencies to get the regulatory relief and additional support they need to respond as rapidly and effectively as possible to protect their most vulnerable residents from this disease,” said Administrator Seema Verma.

The materials encompass checklists for the 1115 Medicaid Demonstration waiver and the 1135 waiver, as well as templates for the 1915(c) Appendix K regarding home and community-based services and the Medicaid Disaster State Plan Amendment.

The guidance for the 1115 Medicaid demonstration waivers, which include the Healthy Adult Opportunity block grant, addresses long-term care enrollment, home and community-based services, and efforts to target specific populations.

For 1115 Medicaid demonstration waivers, CMS reminded states that it set up a fast track review system in 2015. The fast track is intended to streamline the reviewal process for states that already have expanded Medicaid and are looking to further expand to manage the coronavirus pandemic. Now, CMS provided states with a template.

In addition to application templates for the demonstration, the Healthy Adult Opportunity, and demonstration extensions, the guidance also provides an overview of the application components for initial submissions and for extensions. Additionally, it provides guidance for former foster care youth, both for states that have expanded Medicaid coverage to cover the new adult group and for those that have not.

The new section 1115 Medicaid demonstration waivers guidance may be a significant step for the Healthy Adult Opportunity. Experts criticized CMS for the complexity and vagueness of the block grant, among other objections. The new template may make it easier for states to apply for a block grant, so that the only question now is whether they should.

While the waiver provides state Medicaid programs with increased flexibility to channel their spending toward vulnerable populations, the waiver’s incentives for decreased spending may lead to lower eligibility, lower coverage, and less comprehensive benefits.

“Things like a closed formulary reduction and eligibility reduction with prior provider payments. There is actually the potential that in some states, if they did this, they could reduce the number of people covered, they could reduce benefits, things like that,” Chris Sloan, associate principal at Avalere, told HealthPayerIntelligence. “All of those would be negative for beneficiaries and providers participating in the program.”

The second template is for section 1135 Medicaid demonstration waivers. States need only check the stipulations they would like to waive, such as Medicaid authorizations, long term services and supports processes, and provider enrollment requirements.

Two states have already been approved for these waivers.

Florida was the first state to apply and receive approval. The Florida waiver addresses using unlicensed sites of care, lifting certain administrative burdens for nursing homes, and extending appeal and state fair hearing deadlines.

Washington, where the coronavirus is thought to have entered the US, was the second, most recent state to receive CMS approval to enact a section 1135 Medicaid demonstration waiver on March 19. CMS waived certain provider enrollment requirements, prior authorizations, and other stipulations that it also waived for Florida.

CMS also approved three Appendix K applications that waive restrictions on community-based organizations, individual and family services, and populations with disabilities for Pennsylvania, Washington, and West Virginia. The agency provided a pre-populated template specific to the coronavirus pandemic.

Lastly, CMS reminded states of the Medicaid State Plan Disaster Relief State Plan Amendments. The agency designed a template for the coronavirus for this relief as well.

“The tools released today further CMS’s commitment to providing our state partners the resources they need at this time,” the press release stated.