- The Trump administration approved its first state Medicaid waiver to combat the rapidly spreading coronavirus, in Florida, following the Friday declaration of a national emergency.
- CMS is allowing the state to waive prior authorization requirements, make it easier for out-of-state providers to provide care, allow care in alternative settings from a hospital or doctor's office, suspend certain nursing home screening requirements to lower administrative burden and extend deadlines for appeals and state fair hearing requests.
- The federal government stopped short, however, of expanding Medicaid to cover all low-income beneficiaries' coronavirus testing and treatment, something many Democrats have called for as the virus continues to spread.
The national emergency declaration allows CMS to waive usual requirements in Medicare, Medicaid and the Children's Health Insurance Program and expand access to services fighting the disease the novel coronavirus causes, COVID-19.
Florida was the first state to submit a section 1135 waiver, but it's unlikely to be the last as the cases are seen rising. CMS said it expects to review and approve similar waivers from other states in the coming days.
The Trump administration has faced criticism for what many see as a clumsy and reactionary response to the outbreak, which is known to have killed almost 70 people in the U.S. so far. About 3,500 people had officially tested positive as of Sunday, according to the Centers for Disease Control. Experts say those numbers are far lower than the true number of cases as widespread testing remains delayed.
Democrats have urged the administration to expand safety net programs to support low-income and other vulnerable Americans, a step President Donald Trump's health officials, leery of an about-face following months of chipping away at Medicaid and the Affordable Care Act, were thought unlikely to take.
The national emergency declaration opened the door to state agencies to use Medicaid more freely to adapt to the rapidly shifting pandemic. Democratic and Republican administrations alike have loosened Medicaid rules amid crises like 9/11, Hurricane Katrina and the H1N1 flu outbreak in 2009.
CMS last week required Medicare Advantage and Part D prescription drug plans to waive cost-sharing for testing and treatment of COVID-19, including emergency room and virtual care visits.
Florida's waiver will allow the state to expedite enrollment of out-of-state providers for the duration of the emergency, so there will no longer be limits on how many people those doctors can see or how many cases they can treat. CMS is waiving application fee payments and criminal background checks, among other screening requirements, for those providers too.
Florida also asked for permission to temporarily delay Medicaid fair hearings and their 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. CMS is allowing the state to push back the timeline for appeals, letting enrollees request a hearing after zero days if they're denied a claim. All appeals filed between March 1 and June 29 can go directly to a hearing if Medicaid recipients want.
Medicaid beneficiaries also have more time to request a hearing or receive a determination. Additionally, Florida is allowed to suspend a claims denial or other adverse decision and can delay hearings and decisions if they're overloaded but have to prioritize hearings with beneficiaries most impacted by the delay.