UPDATE: March 26, 2020: CMS has approved 10 more state waivers this week, bringing the total to 23. All of the new approvals now have authority to suspend pre-admission screening for nursing facilities. Oregon, North Dakota and Missouri joined Washington state in gaining the ability to change Medicaid rates, premiums and cost-sharing amounts without public notice. The other new states receiving waivers are Iowa, Indiana, Kansas, Kentucky, Oklahoma, Rhode Island and South Dakota.
- The Trump administration Monday approved 11 additional state waivers to expand Medicaid flexibility to combat the coronavirus outbreak in the U.S., bringing the sum total of OK'd waivers to 13.
- The waivers allowed under President Donald Trump's declaration of a national emergency earlier this month allow states to eschew certain Medicaid requirements on physician enrollment and prior authorization as well as free up where care can be delivered and suspend certain nursing home screening requirements to lower administrative burden.
- Alabama, Arizona, California, Illinois, Louisiana, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina and Virginia now have greenlit waivers, along with Florida and Washington, which were the first two approved last week.
The president declared the coronavirus outbreak a national emergency March 13, allowing CMS to waive stipulations in its federal payer programs and open the door to state agencies to use Medicaid more freely to adapt to the pandemic. Florida was the first state to submit a waiver and get it approved March 17, followed by Washington, one of the states hardest hit by the coronavirus, two days later.
The Trump administration has been criticized for what public health experts see as an uncoordinated, slow-moving reaction to the fast-spreading virus. According to the Centers for Disease Control, some 33,400 people in the U.S. have been infected and 400 have died, though experts warn those numbers are far lower than the true number of cases due to a lack of widespread testing.
HHS has ramped up its response, taking steps to drastically expand Medicare to free up funds for the country's COVID-19 response, notably easing back restrictions on telemedicine visits in traditional fee-for-service Medicare. CMS has also required Medicare Advantage and Part D prescription drug plans to waive cost-sharing for testing and treatment of COVID-19, including virtual care and emergency room visits, and urged hospitals to delay non-essential elective surgeries to free up resources for a projected flood of COVID-19 patients, along with removing regulatory barriers to state governments' reactions.
Those states can now suspend prior authorization requirements and certain nursing home screening requirements, provide care in previously unlicensed facilities if patients need to be relocated there, and delay Medicaid fair hearings and decisions, trials a Medicaid beneficiary can ask for if they don't agree with a change or denial in their coverage following their health plan's complaint and appeal process. They can also temporarily enroll providers who are already enrolled with another state Medicaid agency or Medicare, and those that aren't if they meet requirements like being licensed in another state.
California asked for all of the above except lowering nursing facility oversight; New Mexico for all but permission to provide care in alternate sites; Louisiana for all but a removal of prior authorization requirements; and Arizona for all but providing care in alternate sites and a delay in Medicaid fair hearings trials and decisions.
CMS said it was still working on additional waiver requests from Arizona, California, Illinois, Louisiana, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina and Virginia.
California, for example, asked the Trump administration for federal dollars for temporary housing for homeless people if they test positive for COVID-19 or are exposed to the disease, and to waive all costs for testing and treatment for certain Medi-Cal beneficiaries subject to cost-sharing.
The waivers are effective as of March 1 and last for the duration of the public health emergency.