Health Center Regulatory Issues, Health Center State Policy

CMS Issues Informational Bulletins on Waiver Processes

The Centers for Medicare and Medicaid Services’ (CMS’) Center for Medicaid and CHIP Services (CMCS) has issued two informational bulletins on changes to the Section 1115 Medicaid waiver process and State Plan Amendment and 1915 waiver process. The informational bulletins are a follow-up to a March 14 letter from CMS Administrator Seema Verma and then-HHS Secretary Tom Price to the governors outlining a “new era for the federal and state Medicaid partnership,” including increased state flexibilities. These recent letters outline changes to the Section 1115 and 1915 waiver process, such as changes to approval, transparency, evaluation, and monitoring.

These letters were released just before Administrator Verma spoke at the annual meeting of the National Association of Medicaid Directors, where she outlined efforts to streamline the Medicaid program and “a new day” for the Medicaid program.  In her remarks, she noted:

“Our vision for the future of Medicaid is to reset the federal-state relationship, and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve. It’s what I believe we all want. We have an obligation to help those who need it most, and we need to ensure that we are building a Medicaid program that is sound and solvent and helps all beneficiaries reach their highest potential. In order to accomplish this, we are focused on three areas: Flexibility, Accountability, and Integrity.

Today, the CMS website contains new information for states about our expanded vision of what types of projects can achieve Medicaid’s objectives. As you know, demonstration projects offer an avenue for states to pioneer innovative approaches that deliver local solutions to local problems. In support of this, we want to make sure that the lens through which we view proposals is clear, and responsive, to the requests we have received from states. One of the things that states have told us time and time again is that they want more flexibility to engage their working-age, able bodied citizens on Medicaid. They want to develop programs that will help them break the chains of poverty and live up to their fullest potential. We support this.”

Among the efforts to streamline the program, while also providing flexibility to the states, CMS is:

  • establishing an expedited 1115 approval process;
  • considering a 10 year extension for “routine, successful, non-complex” 1115 waivers;
  • establishing a “fast-track” 1115 waiver approval process; and
  • reducing the 1115 waiver reporting burden on states

For SPAs and 1915 waivers, CMS is hoping to reduce the backlog of approval by establishing calls with states within 15 days of receipt of a SPA or 1915 waiver and providing states with a comprehensive request for additional information. They are also considering additional short and long term strategies to improve the process.  For a more in-depth summary of these letters, see this summary.

NACHC is following these changes very closely and working with PCAs and health centers as waivers are being developed in their states.

Looking for more information on waivers? Check out this fact sheet and the waiver section of our website. Interested in what these changes could mean for the Medicaid program? Check out this recent Health Affairs blog.

Contact and with any questions on the letters or other waiver developments.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.